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Full text of "Elements of the materia medica and therapeutics [electronic resource]"

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^ROFE&SGR OF MATERIA MEDIO IN 



Of THE STATE OF S< 'T7TU-r.\ROLIN T A 





THE MEDRAL COLLEM 



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CHARLESTON : 
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/UV'fED BY fRBES & J i WES, 

No. 44 il ueen-ati^t 



1841 







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THE 

ABNER WELLBORN CALHOUN 

MEDICAL LIBRARY 

1923 




Class. 



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Book. 






PRESENTED BY 



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ELEMENTS 






OF THE 



MATERIA MEDICA, 



AND 



THERAPEUTICS 



By 

HENRY R. FROST, M. D. 

« 

PROFESSOR OF MATERIA MEDICA IN THE MEDICAL COLLEGE 
OF THE STATE OF SOUTH-CAROLINA. 



PART I. 



CHARLESTON : 

PRINTED BY BURGES & JAMES, 
No. 44 Queen-street. 

1841. 






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PREFACE 



The following Elementary Treatise has been prepared for the use 
of the class, in attendance upon the Lectures, in the Medical College 
of the State of South-Carolina. Such a work would seem superfluous 
at the present time, abounding in Treatises upon almost every subject, 
and it would not have been undertaken but from the author's connec- 
tion with the College. In this relation, it furnishes the lecturer with 
a work to which he can refer his pupils, as a companion and assistant 
during the period of their studies. The succession of Lectures with 
which the student is daily occupied, renders it proper, that the course 
of studies be facilitated by every practicable method. In no depart- 
ment are such facilities more required, than in the Materia Medica — 
which being addressed more particularly to the memory, requires all 
the aid which can be brought to its support. In addition, he hopes, 
that in his arrangement of his subject, and the articles, in the expo- 
sition given of the operations of medicines, and the Therapeutics 
proper, he has been able to add much to the information usually 
found in the Treatises adopted in the several schools. 

The Introductory Lectures, comprise, in a great degree, matter not 
to be found in any of them, in his view, so important, that it has 
always been a subject of surprise, that they should have been over- 
looked. 

In preparing this part of his labours, he must confess obligations 
to many in this country, and abroad, and more particularly to the 
writers of the French School. To enumerate them all would be a 
difficult task, since, the work put forth, is the result of reading and 
observation for many years, and the thoughts of others have become 
so incorporated with his own, that a separation is not now attainable. 
He has not overlooked the most important sources from which he 
has received assistance, and they will be found appended at the 
conclusion of each separate subject. 






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General View of the Materia Medica. 

Before entering upon the particular consideration of the depart- 
ment which it is my province to teach, I shall devote a few Lectures 
to the consideration of certain general subjects, to which allusion will 
frequently be made in the progress of the course. These will be 
brought to your view in their proper order. 

In the present lecture I shall take a general view of the Materia 
Medica; point out its connection with other studies; the subjects it 
embraces ; and offer such remarks as suggest themselves in reference 
to the object proposed. The Materia Medica, to which also the term 
Pharmacologia has of late been applied, (from Pharmakon, Medicine, 
and Logos, Discourse,) is that part of the study of medicine which 
treats of the various remedies in use. It comprehends a knowledge 
of the intimate composition of these agents, the physiological effects 
which follow their employment upon the system, and the practical 
benefits which are derived from their operation. To obtain all these 
objects in the highest degree, it is proper that we should be acquainted 
with the Physical and Chemical qualities of the substances which 
constitute a medicine, and to know the changes and the alterations 
which these substances experience before they can be rendered useful. 
The study of these several subjects extends the boundaries of our 
science, and brings under its domain a number of others, which be- 
come necessary for its full and thorough acquaintance. 

Natural History is tributary to it, when it searches into the pro- 
ductions of the Three Kingdoms of Nature for the substances which 
are endowed with medicinal qualities. Pharmacy, which is occu- 
pied in converting these substances into medicines, in giving them 
a form which favours the exercise of their properties, is also a branch 
of this science. The Materia Medica is associated with Chemistry, 
when it penetrates into the texture of medicinal articles, when it 
separates the immediate principles which constitute them, when it 
enumerates the number of these principles, and when it determines 
the proportion of each in these compound bodies. 

On the other hand, in tracing the action of medicines upon the 
body, the nature of the impression which is made upon the seve- 
ral organs, and the effects which follow their employment, it is 
necessary that we should recur to Physiology, which teaches the 
action of these organs. With the Practice of Medicine there must 
exist a very considerable and close alliance : for can we speak of an 
article without regarding the diseases to which it is applicable, with- 
out having reference to the assistance which it furnishes in opposing 
.the progress of sickness, and of viewing it as an agent proper to re- 
move, in many instances, the morbid actions which exist? 

With 4his very general view of the connections of the Materia 
Medica, I shall take up the consideration of the natural substances 
employed in medicine. — These, as you already know, are extremely 
numerous. Man, under the influence of pain, seeks relief in every 
thing which surrounds him. Having exhausted all the accustomed 
1 



11. 

sources of relief, he addresses himself to others. Any success en- 
courages his boldness, and substances the most dangerous, and most 
contrary to his organization, are transformed into medicinal means. 
Deprived of any fixed principles in directing his researches after sub- 
stances proper to become medicines, he adopts at first without scruple, 
and without examination, every production which appears likely to 
become useful. Thus it is, that a multitude of remedies of doubtful 
properties are accumulated together; and whatever the Animal, Mi- 
neral, or Vegetable kingdoms Could furnish have been made a part 
of the Materia Medica. The number of these articles I shall much 
curtail, and will endeavour to present to you such only as are of tried 
and acknowledged powers — such as are capable of making upon the 
living structure an impression which modifies its actual state. 

The substances which constitute the Materia Medica are derived 
from one or other of the Three Kingdoms of Nature — from Vegeta- 
bles, Minerals, or Animals. 

From the Mineral kingdom we obtain but few articles in compari- 
' son with the Vegetable ; but this deficiency is supplied by their very 
great activity. " In their pure or metallic state they exert but little 
action upon the system, and any effect they do produce appears to 
arise from their being chemically acted on by the gastric juice. 
When oxidated they become more active ; and still more so when the 
oxide is combined with an acid. The degree of oxygenation consi- 
derably influences their powers : so that from the same metal prepara- 
tions of very different degrees of medicinal activity may be obtained, 
though all agreeing in the kind of action they exert." — Murray's 
Materia Medica. 

It is from the Vegetable kingdom that we are supplied with the 
greater number of articles employed in the Materia Medica. Being 
the products of organization, their composition is more simple, and 
resolvable into a few elements, while the mode in which they are 
formed is much more complicated. Thus the ultimate elements of 
Vegetable substances are few in number, consisting of Carbon, Oxy- 
gen, Hydrogen, and sometimes Nitrogen ; and it is the various com- 
bination of these principles that gives rise to the great variety of 
vegetable products. Combinations of the same elements are formed 
therefore greatly diversified, and properties are derived from differ- 
ences of proportions or modes of union. Hence an infinite variety is 
observed in the productions of this kingdom, and as these productions 
are greatly extended, we are in possession of remedies different in 
powers, and adapted to every state of disease. 

The active principles of plants being influenced by a variety of 
circumstances, particular attention should be paid to whatever relates 
to their growth or preservation. It is important when we wish to 
avail ourselves of their medicinal properties, that we should regard 
the period of their maturity, since to each period of their growth, 
there corresponds most commonly a chemical composition peculiar 
to that stage. The Roots, the Stems, the Leaves, the Flowers arrive 
successively to maturity, when. each of these parts are possessed of 



111. 

properties rendering 1 them capable of being made efficacious medi- 
cines. Before the time of their perfection, these properties are not 
matured — beyond this they are exhausted. 

The Intimate Constitution of Plants is influenced by the soil in 
which they grow, the degree of moisture or of heat to which they 
are exposed, as well as by the portion of light and air which they 
enjoy. These are the causes which affect the functions of the vege- 
table life, which regulate the operations upon which depend the de- 
velopement of all parts of the plant. These causes decide the chemical 
composition which the different parts exhibit, and render deficient 
or abundant the medicinal principles from which the value of the 
article is derived. 

I shall embrace the present opportunity to make a few remarks 
upon the general economy of plants, with directions upon the period 
of gathering and preserving them. I am the more particular, as you 
will find but little said upon this subject in any of the systems to 
which you can have reference. 

Plants are to be gathered from places and soils where they grow 
spontaneously in a dry season, — when they are neither wet with 
showers nor dew, — they are to be collected annually, and those which 
have been kept longer should be thrown away. 

The gathering of roots should always be made when the leaves and 
stalks are dead. There are two seasons when this may be done, the 
Spring and Autumn. Authors are not agreed which of the above 
periods should be preferred in making a collection — some recommend- 
ing one season, and others another. The best period is the Autumn, 
after the sap has descended into the roots. At this season the active 
principles not being engaged in giving nourishment to the plants, are 
collected in the roots, and may be said to be in a concentrated state, 
while in, the Spring they are diluted by the quantity of aqueous fluid 
which the root appropriates to itself, and which in short renders its 
substance soft, pulpy, and almost without activity. Experience has 
shown that the roots of this season are reduced in drying one-half 
more than in the fall, especially those which are large and fleshy. 
They are also liable to undergo a degree of fermentation from the 
quantity of moisture they contain. The Autumn, therefore, should 
be preferred. 

Barks ought to be collected at that season when they can most 
easily be separated from the wood. # The general rule is to collect in 
the fall, the bark of those trees which are not resinous, and in the 
spring those which are. 

Leaves should be chosen when they are most vigorous and in their 
best state. The plant is in that state when the flowers are about to 
unfold. It would seem that the design of the growth, and increase 
of the rich foliage and the gorgeous flower with which Nature deco- 
rates the vegetable kingdom, has for its ultimate object the formation 
of the seeds, and the propagation of the plant. The display which 
we so frequently witness terminates in this act — the fecundation of 
the seeds — since when accomplished the plant fades, withers, and 



IV. 



dies. The leaves, therefore, and every part of the plant, are in the 
" highest state of perfection when the flower is about unfolding, and at 
this period they should be gathered. 

Flowers are to be plucked when lately unfolded. 

Seeds are to be collected when just ripe and before they begin to 
fall from the plant. They ought to be preserved in their proper seed 
vessels. 

In the Preservation of Plants it is proper to pay particular attention 
to the drying of them. It is essential that their desiccation be con- 
ducted in such a manner that the substances so submitted may not 
sustain any alteration in their nature, and that the principles to which 
are attached their medicinal virtues may be preserved. For this pur- 
pose they should, soon after they are gathered, be thinly spread out, 
and dried as quickly as possible, and with a heat so mild that their 
colour be not changed — then preserved in places or proper vessels, 
excluded from the access of light and moisture. 

The following is the method practised in their preservation. Plants 
to be preserved are collected during a dry season, and after the dew 
has been dissipated. All foreign substances should be separated from 
them, they should be stript of the dead or faded leaves, placed upon a 
hurdle or table, and exposed to the heat of the sun, or upon a stove, or 
in a bakehouse. The Leaves are turned several times a day in order 
to renew their surfaces, and they are left exposed until they become 
perfectly dry— that is until they are readily broken in the hand. 
They are then removed and kept in a dry place for several hours. 
The leaves attract moisture so as to lose much of their brittleness. 
They are then preserved in proper places excluded from the light and 
moisture. The best method of preserving the virtues of Plants is that 
practised by the Friends of New Lebanon, in the State of New- York. 
After the leaves are thoroughly dried in the manner I have mentioned, 
they are placed into moulds and firmly compressed. I show you a 
specimen of the manner in which it is done. By this method they are 

preserved from the changes of the weather — from moisture — light 

and whatever tends to injure the properties of the plant. 

Preservation of Roots. They should be gathered as I have men- 
tioned in the fall season. They should be washed in water to get 
rid of the dirt, and some of the mucous substance that would other- 
wise render them mouldy. The larger roots are cut into pieces split 

or peeled — but in most aromatic roots as those of the Umbelliferous 
plants, the odour residing in the bark, they must not be peeled. The 
pieces are spread on sieves or hurdles, and dried in a heat of about 
120° Fahrenheit, either on the top of an oven, in a stove or steam 
closet, taking care to shake them occasionally to change the surfaces 
exposed to the air. Thick and juicy roots, as those of Jalap, Rhu- 
barb, Briony, are cut into slices strung upon thread, and hung in 
garlands. Others, as Squills, are scaled, threaded, and dried in chap- 
lets round the tube of a German stove, or in a hot closet. 

It will be proper to consider the means by which the Medicinal 
Properties of Plants may be discovered. 



v. , ... 

The Sensible qualities of Plants, such as Colour, Taste, and Smell, 
have an intimate relation with their properties, and may often lead 
by analogy to an indication of their powers. Certain it is, that many 
substances which are insipid, and inodorous, rarely possess any virtue; 
and a number of such articles have been discarded from practice. It 
is true, that observations derived from this source will not serve us 
in forming very minute distinctions, but they will be found almost 
always adequate in vegetable productions to enable us to distinguish 
what is innocent and salubrious, from what is noxious and virulent. 
That a foundation exists for this distinction, we would infer from the 
conduct of the brute creation, who in their selections of food seem to 
be directed by the sensible properties of the plants presented to them, 
and it is rarely that any bad effects follow their reliance upon this 
guide. That to a certain extent we can be determined in the choice 
of substances by these characters, we know from the practice of 
mankind, who in the examination of an unknown substance instinct- 
ively apply to the senses for information respecting its properties. In 
respect to Taste it may be observed that what is sweet, agreeable, or 
aromatic, proves nutritive and salutary, while on the other hand 
vegetable poisons are nauseous, acrid, and disgusting. Bitterness, 
when not extreme, denotes a tonic quality, which will stimulate the 
stomach and intestines, and promote the process of digestion. Astrin- 
gency is indicated by a styptic taste : aromatics are stimulating, &c. 
Taste cannot be relied upon, for we know that both Gluinia and 
Strychnia have a bitter taste, yet they differ widely in their effects — 
one being tonic, the other poisonous. 

As relates to Smelling, it may be observed, that strong odours 
are narcotic and often poisonous — Nature thus seemingly protecting 
the more rational part of creation from the pernicious consequences 
which would arise from their use. Notwithstanding what has been 
said upon the subject of these two senses, there are so many causes 
of obscurity and error in these indications that they do not admit of 
very extensive or accurate applications. For such is the diversity 
of tastes, and so difficult is it to reduce them to any precise definitions 
or descriptions, that but few general rules can be formed from them. 

Another means of judging of the medicinal qualities of plants, is 
by paying attention to the Botanical affinities. By these affinities is 
meant, that plants agreeing in their general structure, habit and ap- 
pearance, have also a similarity in their effects upon the system. The 
greater number of authors appear to believe, that plants which resem- 
ble each other in their external form, also resemble each other in their 
properties: but no one has asserted the above fact in such strong 
terms as Linnaeus in his Dissertation upon the properties of plants, in 
which he not only asserts that plants of the same general characters 
have the same properties, but that the same natural orders have pro- 
perties allied to each other, and that even those of the same class 
approach each other in their effects. Jussieu has adopted the same 
opinion. Not only authority, but analogy, confirms the above belief. 
Thus all the Grasses have their seeds of a nutritive and farinaceous 



VI. 

character. Lolium Temulentum, a plant growing in England, an 
exception, said to be deleterious — Festuca Q.uadridentata, a Peruvian 
grass, described by Humboldt, very poisonous and even fatal to ani- 
mals, another exception. The Labiated plants are stomachic and 
cordial — as Sage, Rosemary, Hyssop, Horehound, Lavender, Mint. 
The Umbelliferous have seeds tonic and stimulating — as Angelica, 
Fennel, Coriander, Assafoetida, Ammoniacum. Those of the Euphor- 
biaceous are acrid and purgative — as Castor Oil, Croton Oil, Euphor- 
bia Ipecac, and Ammoniarum Corrollata. The juice of the Coniferes, 
trees bearing cones — as the Pines, Larch, etc., are resinous. The bark 
of the Amentaceffi is astringent and febrifuge — Amentacese, so called 
from the flowers of the trees hanging down in the form of a rope, as the 
Oaks, Hazels, etc. This mode of judging of the plants would seem 
to lead to pretty correct conclusions respecting their properties, and 
experience does in many cases prove that such analogies are well 
founded. For it would be reasonable to suppose that a certain struc- 
ture of the leaves, of the parts of fructification, and of the general 
economy of the plant would lead to a similarity in their secretions 
and properties. This general structure is, in short, what might be 
called the physiognomy of plants, and by observing which we are 
capable in many instances of determining their qualities. When, 
therefore, a new species of any genus is discovered, the discoverer 
may infer that it possesses virtues similar to those of the genus to 
which it belongs. I might illustrate the preceding remarks by exam- 
ples from other of the natural families, but in a study so little known 
as Botany to the generality of students, further details might be tire- 
some. I shall be satisfied with having called your attention to the 
subject and illustrated it by a few examples. It must however be 
observed, that the remarks upon this subject must not be taken in 
an unqualified sense; exceptions do occur, and in some particular 
instances, this close alliance in structure and habit is attended by 
very great differences in effects. As familiar examples, I may men- 
tion the Solanum Nigrum or Deadly Nightshade, and the Solanum 
Tuberosum or Irish Potatoe — the Cucumis Melo or Musk Melon, and 
the Cucumis Colocynthis or Bitter Cucumber. These very great dis- 
tinctions may be in some measure attributed to cultivation, which 
changes the habits and properties of the vegetable as much as it does 
of animal life. To take a few examples — who would suppose that 
the Sour Sloe had by cultivation been ripened into the pleasant 
Plumb, or the austere Crab Apple of the woods into the Golden Pip- 
pen? That the common Col wort by culture, continued through many 
ages, appears under the improved and more useful form of Cabbage, 
Savoy and Cauliflower? Though cultivation has had such influence 
upon the Solanum Tuberosum as to render it one of the most useful 
vegetables which is planted, yet it has not destroyed altogether the 
characters by which it is classified, nor separated it from its kindred 
article, the Solanum Nigrum, since it has been lately shown that 
an extract prepared from the leaves and flowers possesses valuable 
properties as an anodyne remedy. Tlae subject has of late excited 



Vll. 

much attention, and it is admitted that with some exceptions, the 
botanical affinities will afford very important aid in determining trm 
properties of plants. A knowledge of them with the information 
which is to be derived from the sensible qualities, will give to the 
Physician great advantages in his researches, and enable him very 
frequently, without an acquaintance with a plant, to judge qf its 
general properties. It would be desirable that such of you as have 
opportunities of cultivating Botany should make yourselves acquaint- 
ed with this interesting study, at least with its general principles. 
Certain it is, that an acquaintance with its principles will give to the 
physician, in forming his opinions, the same advantages which the 
educated practitioner possesses, over the mere pretender in medicine. 

The several means enumerated, of judging of the medicinal pro- 
perties of a plant, will however be insufficient of themselves — they 
must be subjected to the test of experiment. This is unquestionably 
the most conclusive method which can be pursued, and to which all 
the preceding are subsidiary. When any article has been experi- 
mented with, and certain results follow its administration, they may 
be considered as the effects which will follow its use. When these 
results take place with tolerable uniformity, they constitute what has 
been called experience. This is undoubtedly the highest evidence 
we can desire, and the surest guide when the observations are suffi- 
ciently correct, and the circumstances discriminated in so clear a 
manner as not to create any confusion. Where these requisites • are 
not attended to, the conclusions drawn may be very fallacious, and 
hence such a discrepancy in medical opinions often prevails. 

It may not be amiss to state some of the circumstances which in 
our experiments often lead to false conclusions, and which should be 
guarded against. There are a variety of circumstances which, ab- 
stracting from any suspicion of bad faith in those on whose testimony 
the credibility of facts depends, have a tendency to vitiate the accounts 
of what is commonly dignified by the title of experience. Such is the 
case where the experimenter has some previous opinion to support, 
when it always happens, that the results are considered through the 
medium of his preconceived views. This is so obviously the case, 
that it only need be mentioned in order to show how irreconcileable 
such a state of mind will be, with a candid statement of facts. An- 
other circumstance calculated to weaken the evidence from expe- 
rience is, that admitting there are no preconceived opinions, and a 
jealous exclusion of all theoretical views, still there will always be a 
great deal of doubt and conjecture in whatever appertains to the ope- 
rations of the living system, at least when compared with what is re- 
quired in Chemistry or in Mechanics. From this cause it happens, that 
the operations of nature are often mistaken for those of our remedies, 
and many properties attributed to them which they do not. possess. 
Thus it is that Seneka Snake Root acquired a reputation for curing 
the bite of the rattle snake — that burnt Sponge was a remedy for 
consumption, and in our day that Iodine was calculated to remove 
the equally distressing disease, scrofula. 



Vlll. 

The case of Mrs. Stephens may also be cited as coming under this 
head. — She received a large grant from Parliament for the discovery 
of certain medicines for the cure of the Stone. A committee of pro- 
fessional men were appointed to ascertain its efficacy, and a patient 
with Stone was selected for the purpose of trying the remedy. The 
patient's suffering was relieved upon taking the medicine, and upon 
examining the bladder some time after, no Stone could be felt. It 
was therefore agreed that the patient had been cured and the Stone 
dissolved. Some time afterwards this patient died, and on being 
opened a large stone was found in a pouch formed by a part of the 
bladder, and which communicated with it. — Paris. 

Admitting however that the difficulties I have mentioned in the 
way of acquiring correct experience were less founded. Another ob- 
stacle would arise in the fact, that the description of any medical- 
case, can seldom or ever include all the circumstances with which 
the result was connected, so that though certain effects followed the use 
of any particular article we can not say what were the particular 
conditions of the system, what concurring circumstances tended to 
produce such an effect, or how the system was favourably disposed 
to the action of the agent employed. Therefore though the facts de- 
scribed be true, yet when the conclusions to which they lead come 
to be applied as a general rule in practice, it is often a rule transferred 
from a case imperfectly known, to another of which we are equally 
ignorant. From this cause it happens that such frequent complaints 
are made of the uncertainty of medicine, and that disappointment so 
frequently attends the operation of our remedial agents. The fault 
probably does not depend upon the substance employed, but to the 
want of discernment, or what has significantly been called tact in the 
physician. With the truth of the remarks I have made, in the diffi- 
culties of acquiring correct experience, there are few physicians who 
have been engaged in practice, who will not acquiesce. Do not 
understand me as wishing to undervalue the utility of this highest 
of all evidence, but as suggesting caution in receiving all that is 
referred to this head, and in forming your opini6ns. 

The last method of acquiring a knowledge of the virtues of plants 
usually resorted to, is Chemical Analysis. There can be no doubt 
that from this mode of investigation much useful knowledge may 
be acquired, and considerable insight afforded into the medicinal pro- 
perties of plants. With the discovery of certain principles we are 
led to the virtues and the applications of the article under examina- 
tion. Thus with the discovery of Tannin and Gallic acid, astrin- 
gency is known to exist, and with Resins a cathartic property. 
Gums, Mucus, and Fcecula are emollient, demulcent and nutritious. 
Fixed Oils are laxative, and the volatile are aromatic. Bitter ex- 
tractive is usually tonic, and the acids are refrigerant and antiseptic, 
etc. But though Chemistry unfolds to us the particular principles 
which predominate in a plant, and to which it owes its efficacy ; yet 
it can never take the place of experience, since while it points out the 
number, it has not been carried to that degree of perfection as to dc- 



IX. 



termine their exact combination, the state of chemical union, and 
those nice^proportions of different ingredients upon which the distinc- 
tions between vegetable substances- so frequently depend. 

Carbonic Acid, and Oxalic, are composed of the same ingredients, 
but in different proportions, yet affect the stomach in an. opposite man- 
ner. Quinia, Morphia, and Strychnia, present but slight differences 
in their composition, yet their operation is very dissimilar. 





Quinia. 


Morphia. 


Strychnia 


Carbon . . . 


. 75 76 


. . 72 20 . . 


. . 77 21 


Hydrogen . 


. 7 52 . . 


. . 6 24 . . 


. . 6 73 


Nitrogen . . 


. 8 11 . . 


. . 4 92 . . 


5 96 


Oxygen . . . 


. 8 61 


. . 16 66 


. . 10 10 



The analysis of vegetables has of late been carried to a very great 
extent. It has in several instances been able to seize upon and sepa- 
rate the active principles of a plant from all other ingredients, and 
thereby prove to us that in the substances upon which the experi- 
ments have been made, the active property is a distinct and essential 
principle. Whether the number of these articles will become extend- 
ed, and in each the differences of their action will be found to depend 
upon a distinct substance, or on the combination of the vegetable 
principles already known, time only will determine. In the mean 
time we cannot but acknowledge the very important assistance the 
Materia Medica is daily deriving from that science, and its utility in 
pointing out the medicinal properties of plants. 

From the Animal kingdom we derive but few medicines, and such 
as have been employed are so nauseous, and frequently so inert, that 
they have been discontinued in practice, or nearly so. There are, 
however, one or two articles df great power still in use. 

The substances, then, or medicines which are comprehended under 
the title of the Materia Medica, are derived. from the Three Kingdoms 
of Nature. It is rarely or never that they are simple substances, but 
they are composed of principles which are different in their nature, 
and more or less numerous. This variety gives to each medicine 
properties which are peculiar, and which distinguish them from 
every other. If aqueous, gummy, oily principles, etc. prevail, they 
form medicinal agents, inert, insipid, and without much virtue, which 
are only useful as demulcents. If principles which are bitter, saline, 
resinous, enter into the composition of a medicine, it becomes possessed 
of powers much less equivocal — and these principles enter into the 
majority of those substances which are usually employed. In other 
cases there are found elements so energetic, as to give to the article 
in which they are discovered great activity, insomuch that they may 
become dangerous. These are medicines which contain the vegeta- 
ble alkalis, as the Emetine, the Strychnine, the Morphine, the Bru- 
cine, etc., and which are to be given with great caution and in small 
doses. 

It is easy from this view to conceive, that each medicine is endowed 
with an active power, which becomes sensible as soon as it is brought 
2 



into contact with the living system. Can we develope the essence 
of this action, or penetrate into the conditions of its existence f Not- 
withstanding the difficulties of the subject, the curiosity of physicians 
has been excited to inquire into the cause of this inherent power of 
medicinal agents. They have made various efforts to raise the veil 
which obscures the subject, and have buried themselves in a number 
of researches to discover the sources of it, and to know the causes of it. 
So far we must confess that the means of investigation employed in 
the Physical and Chemical sciences have been useless, and the con- 
jectures which have been formed as to the immediate cause of the 
active powers of medicines generally, have been vague and visionary. 
The effects which follow their action may be conceived to depend 
upon the impression made by their particles upon the organic struc- 
tures, and that the sensible effects which are produced, may be con- 
sidered, for the most part, as a reaction which the powers of the vital 
principle determines in these parts to resist their operation. In the 
application, therefore of a medicinal agent to a living part, if it is capa- 
ble of making an impression, there is an effort excited to resist its ac- 
tion, and from this there results a connected series of movements, which 
are manifestly the efforts of these organs to rid themselves of the 
medicinal substance. This leads to the modus operandi of medicines, 
which will form the subject of the next lecture. 

Having said much upon the Relations of Botany to Medicine, I 
cannot conclude this Lecture without enforcing the study upon you 
from threefold considerations. 

1. Its utility in the stations you are to occupy as physicians. You 
are aware that the most valuable of our remedies are derived from 
the Vegetable kingdom, and that these are influenced in Uheir effects 
by circumstances connected with their growth, age, season at which 
they are gathered, etc. It is therefore highly important that we 

should be acquainted with the organization of the vegetable world 

know the laws. which regulate its increase, maturity and decline 

the changes to which they are subjected at different stages of their 
growth. Without this knowledge we cannot be certain that the 
plant which we are employing is in a state to furnish all the benefits 
which may be afforded. 

A knowledge of this science is further necessary to enable us pro- 
perly to discriminate one plant from another. Common names are 
often so fancifully and arbitrarily applied, often too the same name 
or a slight variety, designating plants totally different in their classi- 
fication, properties, habits, that a degree of knowledge more than is 
commonly possessed is required to distinguish one plant from another 
— to show the fallacies which have determined its title or its appli- 
cation — and to establish in one's mind a correct estimate of the value 
which should be attached to its reputed properties. 

Furthermore, the common people in their discussions upon the 
names and properties of plants, are apt to appeal to physicians as 
umpires in their disputes. When the information sought after can 
be furnished, and that determined by a scientific acquaintance with 



XI. 

the subject, the effect is uniformly favourable to the attainments of 
the physician, and proportionately raises his character. 

In the second place, it furnishes the mind, particularly when the 
scene of our labours is the country, with a source of much and ever 
varying amusement. The faculties of the mind which are called 
into exercise in the pursuit of this study, are such as conduce to its 
improvement as well as to its gratification. With the exercise of 
memory in treasuring up the names and localities of plants, the 
powers of observation become enlarged, and the perceptions are also 
awakened. The mind passes with rapidity from one object to an- 
other — dwells upon its prominent beauties, or dives into a minute 
analysis of its structure — derives pleasure in the order, regularity, 
fitness of parts which are so conspicuous in all, even the most insig- 
nificant of Nature's works. An amusement so rational, while it 
purifies and elevates the feelings, fills up much of the vacant hours 
of life, which often, from no other cause than the absence of occupa- 
tion or a pursuit, are spent in unprofitable amusements, sensual indul- 
gences, or vicious and degrading excesses. Once a Botanist, his 
pleasures are not confined to his immediate climate — the productions 
of other countries invite and captivate him — wherever chance or in- 
clination lead him, he is at home — to him all nature smiles, and 
myriads of objects court his acquaintance, and seem formed for his 
pleasure. 

Lastly, it affords to an improved mind, much and rich food for 
philosophical reflection. 

" Take the phenomena of vegetation, and what a secret world of 
wonders is there in every plant ! Growth, vegetable growth, which 
to the ignorant is a bare and naked fact, is to the scientific eye a 
history, a whole history of things the most interesting to every intel- 
ligent mind. Survey it throughout from its foundation silently and 
mysteriously wrought in the dark and senseless earth until it rises 
up to the stately plant or the towering forest tree — examine its inti- 
mate structure — trace the firm and tough fibres which give it strength 
to resist the storms amidst which it flourishes — observe the ducts and 
channels carefully laid in it to convey streams from the rich foun- 
tains of life below— mark its numerous cells, those secret laboratories 
of Nature — survey all this exquisite and wonderful workmanship, 
and who, I ask, would not know something of all this ? Who would 
not give a little time to procure so great satisfaction ? Who would be 
content to pass through one spring season, and understand nothing 
of these most curious and wonderful processes that are going on 
around him?" — North American Review. 

References. — Traite Elementaire de Matiere Medicate, par J. B. 
G. Barbier; Paris 1 Pharmacologia; Seyder 1 s Examinations ; Cullen's 
Materia Medica; Pereira's Lectures. 



Xll. 

On the Modus Operandi of Medicines. 

Previous to the consideration of the Materia Medica properly so 
called, it may be expected, and it is usual to give some general idea 
of the modes of operation of those articles which I shall present to 
you. This is not a subject of mere speculation, but one upon which 
you will be expected to have such settled views as the obscurity in 
which it is involved will admit. I wish it was in my power to remove 
all the doubts and difficulties which overhang the subject; but as our 
path is checkered and beset with many difficulties, I will endeavour 
to be as good a guide on the way as I can, hoping that it may be the 
good fortune of some of you, to fall upon a nearer and less intricate 
rout. 

The Modus Operandi of Medicines is, as I have observed, an intri- 
cate and obscure subject, one upon which much speculative and 
ingenious reasoning has. been exercised, and one to a physician teem- 
ing with interest. The only point fully admitted upon this subject, 
is, that the operations of medicines do not depend on the laws of 
matter and motion which take place in inanimate bodies, but on a 
principle which exists in living animals only. 

"Medicamenta non agunt in cadaver." — This principle we have 
denominated life, and upon which as controlling and modifying the 
actions of medicines, I shall make a few remarks. What life is, I 
cannot attempt _ to explain, but only the circumstances under which 
it is found. It is found intimately connected with organization, and 
the greater or less perfection of the organic arrangement gives rise to 
more or less perfect life. In the higher orders of animated bodies, we 
observe a variety of functions continually exercised, and from these 
numerous phenomena ensue. In .them we observe a cavity of the 
skull which is filled with the brain — a spinal marrow — nerves of two 
sorts — five senses — muscles partly obedient to the will, partly inde- 
pendent in their action — a digestive canal — vessels and lymphatic 
•glands — arteries and veins — a heart and lungs. From these various 
actioiis arise, and the term life is applied to an aggregate of pheno- 
mena which manifest themselves in succession for a limited time in 
organized bodies. These organs are but so many parts of a machine 
destined for the preservation and support of the animal ; impair these 
health is impaired, and the energies of life — for health and life we 
conclude, are designed from the animal mechanism; destroy any of 
these organs of importance to the system, and health and' life are 
destroyed. The misfortune is, that life has been considered as a 
principle existing by itself, and independent of the actions by which 
it is manifested. It has been considered as distinct from trie body 
and as separable from it. Organization is however essential to life 
and it can no more exist without it than gravitation without weight. 
By one class of writers the phenomena of life have been ascribed 
to organic structure, just as the sounds of a musical instrument are 
referred to the mechanical arrangement of its parts. 

By another class it has been assumed, that there exists a living 



III). 
I 

internal principle, (some have compared it to the electrical,) distinct 
from the body, and which is the cause of the organization. — Barclay 
on Life and Organization. 

Of the nature of this principle we can know nothing, and all 
attempts to explain it have terminated in absurdity. We can only 
judge of it by its effects. These we know are a capacity of resisting 
the combined action of heat, moisture, and air. to which the body 
yields when deprived of it. Here chemical operations commence 
which tend to its destruction, and it is these laws which are kept in 
subjection while vitality continues. The latter maintains our exist- 
ence, while the former is our perpetual enemy, we may say. By a 
preponderance of the one, we are kept in health — by a preponderance 
of the other wc become diseased, we die, and are decomposed. Be- 
tween these laws, therefore, there is a constant struggle. 

Another property inseparable from vitality, is the capacity of adding 
to the growth and increase of the sj^stem. The conversion of alimen- 
tary matter into a nutritive fluid, and its assimilation, experience no 
interruption while the animal is in health. 

Caloricity, or the power of animated bodies to maintain a certain 
temperature in every variety of latitude, is another property peculiar 
to life. Such are the effects of this wonderful principle. We do not 
know of it in a separete and distinct state of existence, and only be- 
come acquainted with it in connection with organic arrangements. 

Upon the subject of Physiologj^ and the principle of Life particu- 
larly, Bichat has written much, and has added more original matter 
than any writer that has preceded him. His essential doctrine is, 
that there is no one single, individual, presiding principle of vitality, 
which animates the body, but that it is a collection of matter, gifted 
for a time with certain powers of action, combined into organs which 
are thus enabled to act, and that the result is a series of functions, 
the connected performance of which constitutes it a living thing. 
This is the most simple and general view of life. 

In considering the subject further, he points out two remarkable 
modifications of Life as considered in different relations ; — one com- 
mon both to vegetables and animals, the other peculiar to animals. 
The one he calls Organic Life, and the other Animal Life. By or- 
ganic life food proper for our nutrition is submitted to the operation 
of digestion, is thrown into the circulation, undergoes the action of 
the lungs, and is then distributed to the organs to be applied to their 
nutrition. This is the life by which all parts of the body are kept 
in a state of repair ; it is the life of waste and supply. By animal 
life, we become related to the world around us ; the senses convey to 
us a knowledge of the existence of other things besides ourselves — we 
feel, we reflect, we judge, we will, we react upon external things by 
means of the organs of locomotion and voice, we become capable of 
communicating and receiving pleasure and pain, happiness and mi- 
ser v. In fact, by organic life we merely exist negatively — by the 
animal that existence becomes a blessing or a curse, a source of enjoy- 
ment or suffering. For farther differences between these two lives, I 



XIV. 

must refer you to Bichat's Researches on Life and Death, a work 
replete with interest. I have said thus much upon a subject about 
which we cannot have settled views. I have stated such as seem to 
me most correct, and as much as was necessary for my purpose, for it 
is by the agency of life that medicines operate, and have their actions 
modified. 

In proceeding to speak of the Modus Operandi of medicines, I enter 
upon a field of controversy, in which every step has been the subject 
of attack and defence — a field in which the contending advocates 
have been as irreconcileable, -as partial and contracted views could 
make them. Theories having nothing for their support but the zeal 
and plausibility of their founders, built upon limited views of the sub- 
ject, and the purport of which has been to bend all the operations 
of the system to suit their convenience, have been successively ad- 
vanced. The decline of one has had no other effect than to give 
birth to another, equally slender in its structure and evanescent in its 
duration. I shall therefore adopt no theory, but avail myself of such 
facts as are known ; and without confining myself to one system of 
organs, shall bring to my aid the support which can be afforded by 
other organs, in adding clearness, and, I hope, more correctness to our 
opinions upon this obscure and intricate subject. 

In commencing to speak of the action exercised upon the animal 
economy by medicinal substances, it is necessary to present to your 
view the various parts of the body to which it is customary to apply 
them. These are, 1. The Stomach and Intestinal Canal; 2. The 
Blood Vessels ; 3. The Skin ; 4. The Olfactory Nerves. Other parts' 
are occasionally resorted to ; they are the extensive surface forming 
the serial passages of the Lungs, the interior of the Mouth, the Ure- . 
thra and Bladder, and in women the Vagina. 

First. Their impression upon the stomach and intestinal canal. As 
the stomach is the receptacle of all. that is taken into the system — as 
it is endowed with so large a share of nervous energy — as its connec- 
tions are so numerous and extensive, it must be obvious, that impres- 
sions made upon it, will be greater in degree than upon any other of 
the divisions I have mentioned. The stomach is possessed of powers 
which place it — I might say, could they be insulated — above those 
of any other organ of the body. These 'it derives not only from the 
important .offices it performs, but from its seat and connections. The 
nerves it receives from the brain and splanchnic ganglions, not only 
augment its sensibility to a very considerable degree, but favour the 
transmission by sympathetic connections, of medicinal influences to 
every part of the body. Intimately connected with the head, the heart, 
the lungs, the stomach seems to divide with these organs the impres- 
sions which medicinal agents make upon it. Not only in a physio- 
logical point of view is this organ of the greatest importance, but it is 
no less so in a pathological. Not only is it affected in most diseases, 
but when diseased itself, derangement of the whole system ensues. 
Hence pains of all kinds succeed, in the head and limbs, with heat, 



XV. 

nausea, loss of appetite, anxiety, and these symptoms constitute a 
disease which appears to affect the whole frame. 

The two properties of the stomach upon which the impressions of 
medicines are made, are its sensibility, and irritability. By the former 
is meant that condition of the stomach which is fitted to have pecu- 
liar effects produced upon it by the action of other bodies, and which 
seems to lodge in every part of the nervous system. And that con- 
dition of the stomach by which certain parts are fitted to have certain 
motions of contraction excited in them by an impulse made upon the 
parts themselves, is called' its irritability. I would therefore conclude, 
that the peculiar effects of substances in general, and of those sub- 
stances we call medicines, depend upon their impression on the sen- 
tient and irritable parts of the stomach. But what is the nature of 
this impression ? Is it merely an increase of the vital energies of the 
part, or does a change take place in their actions ? That an increase 
of the energies of the organ takes place, is obvious from the pheno- 
mena which ensue. The capillary vessels become enlarged and dis- 
tended with blood — the temperature of the part is increased — the 
secretions emptying into the organ are all augmented to a considera- 
ble degree — the muscular fibre is stimulated to contractions of a more 
vigorous and active character. This impression, it may be remarked, 
is not the same in all cases. It varies according to the quality of the 
article. It is different when excited by alcohol, by opium, by mer- 
cury, by jalap. It is modified in every variety of manner according 
to constitution, habit, the situation of the part, the nature of the 
stimulant, the state of disease. We cannot therefore decide upon the 
exact nature of the impression — we only know that it is one of a 
decided character, consisting in an increase of the vital energies of 
the part, and that from them very important effects are derived in 
the treatment of diseases. 

I may next inquire, whether to an increase of action produced by 
the impression of medicines upon the stomach there is not also a 
change of action? That a change ensues might be inferred from 
the circumstance, that medicines act upon the organized tissues 
of the body; these tissues form the organ, and execute the func- 
tions which are recognized as performed by that organ. A me- 
dicinal substance producing a change in the state of the tissue, in 
like manner produces a change in the movements of the organ to 
which this tissue belongs ; the function therefore which the organ 
performs, is executed in a different manner, and with particular 
modifications. 

To render this point more clear by examples, I will state that 
emetic substances act upon the mucous coat of the stomach. This, 
with the muscular coat, contributes to the formation of that organ, 
and from them are produced the functions or phenomena which ap- 
pertain to it. The emetic, therefore, producing a change in the 
movements of the organ, its functions are performed in a manner 
different from what is usual, or are in other words changed. There 
can hardly exist a doubt but that such a change takes place in the 



XVI. 

example just given, and the effect would be still more striking if the 
medicine instead of being taken during sickness, was administered to 
one in health. Many ouier examples might be furnished in which 
the disturbance of the organ is not so apparent, yet judging from the 
effects which follow the impression of the medicine, there would: be 
as little hesitation in the conclusion. Such, in short, is the irritable 
nature of the internal surfaces that every impression is attended with 
some change. This change, according to the manner in which it' is 
made, may either remove or bring the organ back nearer to the state 
of health, and it is only by such sanatory efforts being made, either 
locally or generally, that we can even expect to restore the organ 
or system which has been deranged in its action, by the influence 
of morbid causes. 

In considering the actions of medicines upon the stomach and ali- 
mentary canal, regard must be had to their secondary as well as 
immediate effects. The remarks I have made must be considered as 
referring to the latter. It is proper, therefore, that I should say a 
few words upon the secondary operations of medicines. These I need 
scarcely state, follow, as consequences of the impression of medi- 
cinal substances upon the alimentary canal. They are of infinite 
importance, and it is frequently to obtain their full influence on the 
system, that medicines are administered. It is to them that we are 
to attribute the relief which takes place in the developement, pro- 
gress, and effects of disease — to them that we are frequently to ex- 
pect the mitigation of some symptoms, the removal of others, and the 
entire, change which is effected in the actual condition of disordered 
structures. 

To illustrate these remarks, by the action cf several classes of 
medicines. The primary effects of emetics are the impression of the 
article upo'n the mucous coat of the stomach, the inversion of that 
organ with the upper portion of the duodenum, and the evacuation 
of their contents, — the secondary, the change which has taken place 
in the distribution of the fluids, the relaxation the system undergoes, 
the diminution of action, the reduction of the disease. 

The operation of cathartics equally illustrates the above views. 
The effect of their-impression is an increase of all the intestinal se- 
cretions, the serous in particular becoming augmented in a considerable 
degree, with those of the pancreas, liver, mucous glands, etc. From 
all these sources the discharges become very considerable, and the 
operation on the constitution, or the secondary effects, are exhibited 
in the dimished force and fulness of pulse, the reduction of inflam- 
mation wherever situated, the removal of pain, a more equal circu- 
lation of the fluids, the secretions more regularly performed — in short, 
the system under the influence of this new irritation of the intestinal 
surface becomes essentially altered in its actions. These views may 
be further confirmed by considering the action of various ol 
of stimulants, narcotics, antispasmodis, epispasiies, in all of which 
the secondary effects of the articles are of the utmost cemfcequexjee in 
our treatment. Those effects in some of [Ce 



xvn. 

the stimulants and even the narcotics, follow their administration so 
promptly, that we cannot readily draw a distinction between the first 
and second impressions ; but though prompt, an interval may be con- 
ceived, since in every instance the action is first exerted upon the 
sensibilities of the stomach, from thence it is extended to the brain, 
and from thence to the system at large. The organs sympathising 
with the brain in the strongest degree, exhibit the influence of its 
action strongest — the heart becomes soonest excited and the increase 
of the circulation, the first evidence of its excitement. The nervous 
system is therefore the channel through which we most readily ope- 
rate upon the general system, but it is not the only one. 

The Blood vessels or the circulation afford another. Few subjects 
have undergone greater discussion than that of the Introduction of 
Medicines into the Circulation. The opinion that they entered the 
circulation, originated with the advocates of the Humoral Pathology, 
a doctrine which prevailed at different periods to a considerable ex- 
tent, and of which the celebrated Boerhaave was the most zealous 
advocate. This doctrine attributed all morbid phenomena to the 
disordered condition of the fluids or humors of the body, and attempt- 
ed to explain the progress and changes of diseases by certain fermen- 
tative or digestive operations of the humours. According to their seve- 
ral conceived conditions was the nature of the remedies employed ; — 
they were denominated from the effects they were supposed to pro- 
duce. Thus they were antacids, and antalkalies, diluents, demulcents, 
inspissants, with others, as phlemagogues, hydragogues, cholagogues, 
etc., according as any of these principles prevailed, or any particular 
object was to be accomplished. Many of these terms are still retained, 
though employed in a sense widely different from what prevailed 
during this very imrpefect state of Pathology. 

However erroneous were many of the conclusions drawn from morbid 
appearances, and which were adduced in support of this doctrine,* still 
there are many facts in the production of diseases which cannot be ex- 
plained otherwise than upon an altered, and I may say diseased condi- 
tion of the fluids. The experiments of Dedier and Couzein prove that 
the blood and bile are morbidly affected in the plague. Dr. Francis 
Home practised the inoculation of measles with the blood of morbillous 
patients, in several instances with complete success. The communica- 
tion of the small-pox to the fcetus in utero is inexplicable on ahy other 
ground. In the Memoirs of the London Medical Society, a case is 
related by Mr. Turnbull, of a lady who was inoculated in the seventh 
month of her pregnancy. Nine days after the eruption she received 

* The occurrences adduced in support of this doctrine, were — the formation 
of chalk stones after inflammatory gout, the expectoration of purulent and mu- 
cous sputa in consequence of inflammation of the lungs and the bronchial pas. 
sages, and the buffy coat which is formed upon the surface of blood drawn in 
inflammatory diseases. These occurrences were adduced as the strong supports 
of this doctrine, and were supposed to be the peccant matter of the system which 
was eliminated and expelled in this manner. They are explained at present by a 
morbid action of the vessels of the part, on the system generally. 
o 



XV111. 

a fall, and in a few days after was delivered of a dead child, which 
was covered with variolous pustules in a state of suppuration. The 
matter was proved to be variolous, from its communicating the dis- 
ease to several persons who were inoculated with it. One or two 
instances of a like nature are related by Dr. Hosack. It is also well 
known that the lues venerea is communicated from the mother to 
the fetus in utero. If then the - poison of contagious diseases can 
circulate in the sanguiferous system without injury, why may not 
medicines also pass into the system with impunity? 

The principal argument advanced against the introduction of foreign 
substances, is the change which all substances undergo, before enter- 
ing the circulation. It is said that the glands, so commonly met with 
in the course of the absorbents, assimilate the fluids conveyed by their 
vessels, and prevent the passage of any foreign substance. Plausible 
as this statement may seem, the blood is however a very heterogeneous , 
fluid, and were it my province I could- satisfy you fully on this point. 
I am however to prove, that medicines, notwithstanding the above 
objection are frequently conveyed into the circulation, and though 
many authorities could be adduced on this subject, I shall content 
myself with the experiments of Magendie, as repeated and confirmed 
by Drs. Laurence and Coates of Philadelphia. These experiments 
prove very satisfactorily that foreign substances are admitted into the 
circulation, and that by three several channels, viz. : the branches of 
the vena portce, the cesophogeal veins, and the lacteals. The article 
they experimented with was the Prassiate of Potash. This article, 
they observe, has advantages in inquiries of this kind, as being at 
once more easy of absorption, and of exposure by chemical means, of 
all the different substances they had tried. It was introduced into 
the alimentary canal of different animals, and after sufficient time 
had elapsed, it was tested in the thoracic duct, in the blood, in the 
urine, and found to exist in these several fluids. 

Experiments made with solutions of the Sulphate of Iron injected 
into the abdomen, and the cellular tissue of cats and kittens, evinced 
when the fluids of the thoracic duct, or the blood, or the urine, were 
tested with the Prassiate of Potash, the presence of iron. They like- 
wise observe in their experiments with Camphor, that there is positive 
evidence that it may and does pass through the system of the blood- 
vessels. In two experiments with Assafcetida, this substance per- 
vaded the whole system in a short time. They remarked, however, 
that the smell of assafcetida predominated in the mucous surfaces. 
From these experiments there can be no hesitation in admitting the 
introduction of foreign substances into the circulation. 

Further discoveries have been made, and it was distinctly proved, 
that artificial chemical qhanges can take place in the fluids while 
they continue to circulate in living vessels, and the ordinary actions 
of life go on. To prove this point, a solution of the Prassiate of Pot- 
ash was thrown into the abdomen, and a solution of the green Sul- 
phate of Iron into the cellular tissue, in order to try whether the well 
known result of their admixture, — the Prussian Blue, would be pro- 



XIX. 

duced in the vessels. This, however, did not take place, and the ex- 
periment was repeated, and varied, by throwing the Sulphate, as 
being- of more difficult absorption into the abdomen, (where the pro- 
cess of absorption goes on with more facility,) and the Prussiate into 
the cellular membrane. On performing; this, they were gratified by 
the striking result of a distinct and beautiful blue in the thoracic 
trunk and its contents, and in nearly the whole substance and surface 
of the lungs. These viscera were preserved in spirits. Thus, they 
add, not only foreign, but a pulverulent substance could present its 
unnatural stimulus, circulate through the vessels, and could accumu- 
late in th§ lungs, without preventing the actions of life, and without 
occasioning coagulation of the blood. The experiments of Magendie, 
as confirmed by these gentlemen, whose character for talent and 
veracity entitle them to our highest confidence, may be considered 
conclusive on this subject. 

We have, then, from the experiments of these gentlemen, the foun- 
dation laid for future researches, and for enlarging our ideas upon 
the operations of medicines. Their experiments will have contributed 
to form a new era in physiology, and will tend to form new and more 
correct views of the operations of medicines. They have opened to 
us other channels by which foreign substances may be introduced into 
the circulation, besides the lacteals — have proved to us, that these 
substances are introduced into the circulation, and in a shorter period 
of time than could have been anticipated — and that they could exist 
there as chemical substances, without having their nature altered 
and animalized by the action of the vessels through which they have 
entered the system. These are points of primary importance in the 
investigation of our subject, and will doubtless operate powerfully in 
removing the prejudices which have long been entertained relative to 
the admission of foreign substances into the- mass of circulating fluids. 
Hereafter, when we hear of sympathy, applied as it has been as, the 
rationale of every change produced by the action of active agents 
upon the body, we shall listen with astonishment, and wonder at the 
credulity of the times. 

Besides these articles, there are various others of the introduction 
of which into the circulation, the most sceptical cannot but be con- 
vinced. Of these are Potash, Soda and Nitre, which are carried into 
the circulation, and which may be detceted in the urine. Let any 
person, says Dr. Paris, take several doses of Nitre, taking care that 
the bowels are not disturbed by the medicine, and he will find, by 
dipping some paper into his urine, and afterwards drying it, that it 
will deflagrate upon being inflamed, and indicate the (presence of 
Nitre. 

I might multiply facts and authorities to a greater extent, and not 
only relate results derived from an examination of the blood, but 
from the milk, the saliva, the urine, and the bones. Thus the urine 
is often coloured by taking large doses of Rhubarb or of Saffron ; it 
is not only coloured, but acquires a peculiar Odour from Asparagus. 
We sometimes discover in the perspiration the effluvia of volatile 



XX. 

substances, as the Oil of Lemons, and other matters which have been 
ingested. The pulmonary exhalation is frequently affected with the 
odour of Garlic, of Onions, of Alcohol, of iEther, of Camphor. The 
colouring matter of Madder is found in the excretions, and particu- 
larly unites itself to the bones. 

We discover in milk, the bitterness of many plants, the acrimony 
of others, the fcetor of others, when the animals which furnish it 
have fed upon them. These effects necessarily follow from the ad- 
mission of foreign substances into the circulation. They have been 
proved to be admitted by the experiments I have detailed to you, and 
I might greatly multiply their number, but conceive thglt a single 
experiment detailed by an unbiassed individual, and conducted upon 
philosophical principles, worth a hundred others, the authors of 
which are unknown and their prejudices and views still more so. 
I shall go on to state that not only foreign substances may fce intro- 
duced into the circulation, but that they may be injected into the 
veins, and produce effects similar to their introduction into the sto- 
mach. Thus we are informed by-Haller, that a poison or medicine 
injected into a vein will produce certain determinate effects — as 
vomiting in the stomaclvpurging in the intestines, and drunkenness 
in the brain. From experiments made by Mr. Milman it appears, 
that solutions of Tartarised Antimony injected into the jugular vein, 
have produced effects similar to those produced by their introduction 
into the stomach. He dissolved 15 grs. of Tart. Antimony in half 
an ounce of warm water, and injected it into the left jugular of a full 
grown terrier. In two minutes he vomited profusely, and appeared 
greatly distressed' and debilitated. , In twenty minutes violent vomit- 
ing and purging commenced — he became very weak, his stools pass- 
ing involuntarily. In thirty-five minutes he expired. Solutions of 
Gamboge and Scammony produced the same effects as if they were 
introduced into the bowels. Effects corresponding to the nature of 
the article have followed from injecting solutions of Opium, Nitre, 
and other substances, and, they have lately been employed in the 
treatment of diseases.. Magendie has injected warm Water into the 
veins of a patient afflicted with Hydrophobia, and solutions of Opium 
have been employed in Tetanus. The following case was taken 
from the Philosophical Trans. Abridg. Vol. iii. p. 234. We have 
injected by a. siphon about 2 drachms of a laxative medicine into the 
median vein of the right arm of three patients in the Hospital of 
Dantzic. One of the patients was a lusty, robust soldier. He, 
when the purgative liquor was infused into him, complained of great 
pain in his elbow, and the little valves of his arm did swell so violently 
that it was necessary by a gentle compression of one's finger to stroke 
up that swelling towards the patient's shoulder. Some four hours 
after it began to work, not very troublesome, and so it did the next 
day, insomuch that the man had five good stools after it. The other 
cases are similar in their results. 

From the details I have given you, founded upon the experiments 
of very distinguished individuals, there cannot exist a doubt, that 



XXI. 

active substances may be introduced into the circulation in their 
original state, and that so far from being productive of ill conse- 
quences, they may be made subservient to beneficial purposes. The 
advantages we derive through this channel in the operations of medi- 
cines have not sufficiently been enlarged upon by medical writers. It 
is my firm belief that many articles of moderate and feeble powers 
of action, those the operation of which is so gradual as to be neces- 
sarily continued for a length of time — those whose action is exerted 
upon organs removed from the centre of , the system, as the kidneys, 
bladder, skin, lymphatic glands, genital organs, exert a beneficial 
effect through the medium of the circulation. In these cases not 
only are the substances taken into the calculation, but the blood 
itself is changed, and by this means great changes are effected in the 
solids of the body. This is especially the case with some if not most 
of the tonics, particularly the preparations of iron; it is the case with 
all those articles termed Alteratives, whether of the vegetable or 
mineral kingdom, and it is particularly the case after long courses 
of mercury. In the last case the blood is observed to be not only 
more fluent, but of a darker colour than it appears to be when taken 
from persons in health. 

I am aware of the objections which may be made to the view that 
I have taken, and that it may be urged that the changes in the fluids 
can only be effected through the solids. This I shall admit in part, 
though not exclusively. Action and reaction are mutual — and while 
changes are effected through the solids — others, I maintain, are im- 
pressed through the medium of the fluids. The animal system is a 
complex structure, consisting of solid and fluid parts whose influence 
upon each other is constant and mutual, and whose individual inte- 
grity is equally essential to the support of the general fabric. It is 
reasonable to conclude from such a view, together with the positive 
evidence there exists of the admission of foreign substances into the 
circulation, that the fluids may become morbidly deranged and in- 
volve the solids in disease, and that through either impressions may 
be made of a character calculated to obviate or correct these de- 
rangements. — Medical Recorder. 



Subject Continued. 

It may be observed, that all the Natural substances which are 
medicinal are not equally susceptible of absorption. They are not all 
taken up with the same facility by the vessels which perform this 
function. The experience of Tiedeman and Gmelin proves, that the 
metallic salts, those of iron, of mercury, are expelled in the largest 
proportion with the fcecal discharges— whilst the odour of assafcetida, 
of camphor, or musk, is not very sensible at the termination of the 
small intestines and in the large. The substances which are admin- 
istered dissolved in a fluid, those which are presented to the orifices 
of the absorbents, united with the serum which is exhaled from the 

\ 



XX11. 

surfaces to which they are applied, are absorbed very rapidly, and 
with a facility which would not readily be conceived. 

The saline preparations are readily absorbed, insomuch that infants 
at the breast are operated upon by saline medicines given to the 
mother. # 

The colouring matter of rhubarb, saffron, madder, etc. is readily 
taken up. 

The Medicinal substances, on the other hand, which are given in 
a dry or pulverulent state, those the principles of which do not readily 
unite themselves to the fluids which moisten the mucous surface, 
enter with difficulty into the channels which ought to convey them 
to the mass of blood. ' Cinchona in substance an article of this de- 
scription, Magnesia, Jalap. The absorption of these substances is 
therefore difficult — they traverse the intestinal canal, and are to be 
found in the large intestines. It sometimes happens, however, that 
a greater or less quantity of these articles penetrate into the system 
and are found mixed with other substances. The absorbents, as you 
perceive, are elective in their operations — or, to use the fashionable 
word of the day, they are eclectics. 

I shall now offer a few considerations upon the conditions of the 
surfaces favouring or retarding absorption. In the first place, it is 
necessary that the articles designed to be absorbed be closely applied 
to the mouths of these vessels. If the application of the substance is 
not immediate, it is excluded in a great measure from the system. 

Secondly. The absorbents do not exhibit equal activity in every 
part of the intestinal or mucous surfaces. There are parts where 
their action is prompt, active, and very powerful ; and there are 
others where they are inactive. The practitioner ought therefore to 
consider the condition and the physiological activity of the surface 
to which his medicines are applied. 

Thirdly. The absorbing surfaces should not be in a diseased state, 
since this will modify necessarily the exercise of their action. Would 
it be possible to derive the same advantages from a surface in a state 
of relaxation, or which has its vital powers impaired, or otherwise 
irritated, as from' a healthy surface ? 

Fourthly. The general condition of the system will also much 
impede the absorbent action. Magendie has shown that a state of 
plethora retards this function. He has shown at the same time that 
depletion from the blood vessels has restored this action to all its 
energy. This is an important consideration in the application of our 
medicines, «inc& it proves that we cannot calculate upon the effects 
which depend jipon the absorption of a medicine, when administered 
in a disease in which the pulse is strong and full, in which the blood 
is carried with energy into the extreme vessels ; at the same time it 
will be seen that it is only necessary to reduce action, to deplete the 
vascular system, to restore to the absorbents their due degree of ac- 
tivity. These remarks become useful in the therapeutical applica- 
tion of those articles,' which depend upon their introduction into the 
circulating system, before they become efficient. They show the 



XX111. 

impropriety of endeavouring to obtain the curative operations of medi- 
cines, in all conditions of the system, and the necessity of studying 
its various states, ere we can expect the same results. Thus it is 
admitted generally, that the preparations' of Mercury are introduced 
into the system, yet all practitioners will admit the difficulty in many 
instances of affecting the salivary glands, the test of their action in 
highly excited states of fever. 

Having fully considered every point connected with this interest- 
ing division of my subject, I proceed to another. According to my 
arrangement I. am to consider what action medicines exert through 
the medium of the Skin. 

The whole cutaneous surface seems to be endowed with some 
sensibility to impressions, and as it possesses an intimate connection 
with the stomach and alimentary canal, the liver, and most of the 
other organs, it might be considered as one of the widest avenues to 
the introduction of diseases, and to the operation of remedial mea- 
sures. Accordingly, it has long been the received opinion, that medi- 
cines applied in this manner were absorbed by the lymphatics, and 
thus conveyed into the circulation. But though such was the con- 
clusion on this subject, I have no hesitation in stating, that I think it 
was embraced without due consideration ; and as the subject has 
been examined within the last few years, with much accuracy and 
attention by several distinguished persons, 1 shall briefly relate the 
experiments upon which the opinion 1 have delivered has been 
founded. 

The first experiments in opposition to the doctrine of Cutaneous 
Absorption are those detailed in a Memoir by Mr. Seguin of Paris, 
which were read before the Royal Academy of Sciences as early as 
the year 1792. In this memoir the author contends, that while the 
article is entire, the skin does not absorb air or water. 

Dr. James Currie was the next writer on the subject. His experi- 
ments and' observations, as far as they go, are very satisfactory in 
disproof of the absorption of water by the skin — (See his Treatise on 
Cold Water.) In the year 1788, while at Buxton, he experimented 
on the effects of Bathing on the weight of the body. He was weighed 
before entering the bath very accurately, and after remaining im- 
mersed for half an hour or more, he was weighed on coming out, 
when he found his weight rather diminished than increased. These 
experiments he repeated in baths raised to the temperature of 82a 
Fahrenheit, without any increase of weight being produced. 

To these experiments it might be objected that the vessels of the 
system were full, and that no absorption would take place ; yet that 
if. the body was wasted from a want of proper food through the 
stomach, the plastic powers of nature would be employed to supply 
the defect, and to excite an absorption through the pores on the sur- 
face. To prove that this does not happen, Dr. Currie relates very 
minutely a remarkable case of Dysphagia, where death was the con- 
sequence of inanition, notwithstanding that the patient was placed 
in a bath of milk, and every other such method to support the sj r stem 



XXIV. 

was employed. The patient on different occasions stepped perfectly 
naked upon Merlin's balance immediately before immersion, and 
again immediately after it, the body being previously dried. The 
weights were never moved. The result was surprising, for Dr. Cur- 
rie could not distinguish the slightest variation in the weight of the 
body, though the beam would have detected a single drachm and 
though the immersion had continued for an hour. — Currie 1 s Medical 
Reports. 

These facts are very strong in themselves against any power of the 
absorbents of the skin to take up water or other nutritive fluid. But 
though this point may be considered as settled by the experiments of 
Dr. Currie, it may still be questioned whether medicines may not be 
taken up by this channel and carried into the circulation, since it has 
been an opinion not only among the ancients but among the most 
celebrated physiologists of the present time. It is known that tobacco 
applied to the skin produced sickness and vomiting, that opium pro- 
duces sleeps when externally applied ; and these effects were all ex- 
plained upon the supposition that the substances were absorbed and 
carried into the circulation. The experiments of Seguin and Currie 
seem to have directed a spirit of philosophical investigation to the 
functions of the skin, and the subject has been carefully examined in 
this country in a manner highly creditable to the several gentlemen 
so engaged. These gentlemen were, Drs. Klapp, Dangerfleld, and 
Rousseau, who in a series of well conducted experiments, have deter- 
mined that the skin has no power of absorption in its natural condi- 
tion — and that if it does ever absorb, it is only in paticular situations. 

The articles for their experiments were such as produce a charac- 
teristic impression upon some of the fluids of the body. Spirits of 
Turpentine was one of these, and its presence in the system is denoted 
by its communicating to the urine the smell of violets. The manner 
in which the experiment was conducted was as follows: — 

The hand or foot was immersed in a vessel containing Spirits of 
Turpentine, and kept in it for an hour or more. At the expiration 
of this time it was removed, and in the course of a few hours the 
urine was found to be impregnated with the smell of violets. From 
this experiment it is evident that the Spirits of Turpentine was taken 
into the system, and that the test of its presence could be detected. 
It was, however, doubtful whether the Turpentine was conveyed 
through this channel or another suspected source, which was the 
lungs. To ascertain this point, the experiment was varied in some 
degree. A jar filled with Spirits of Turpentine was inverted over a 
mercurial trough, in such a manner that none of the fumes of Tur- 
pentine could escape. In this situation the hand and wrist were: 
introduced into the jar of Turpentine, and kept there for an hour or 
more. It was then withdrawn, well washed, and in the course of an 
hour, the urine was attended to, but there was not the slightest smell 
of the odour of violets to be detected. The conclusion therefore 
which would follow from this experiment would be, that as in one 
instance the presence or Turpentine was detected in the urine when 



XXV. 

a part of the body was immersed in it, and while the fumes of Tur- 
pentine circulated in the atmosphere ; and that in the other instance 
when a part of the body was equally immersed and the fumes pre- 
vented from rising, there was no test of the presence of the article in 
the system, that its introduction in the former case might be attri- 
butable to the vapour of Turpentine being carried into the lungs in 
the ordinary process of respiration. 

To render the point certain, another experiment was instituted. A 
glass vessel containing a quantity of atmospheric air was inverted in 
quicksilver ; three or four ounces of Spirits of Turpentine were intro- 
duced into it, and agitated with the air contained in the vessel in 
such a manner as to intimately mix the vapour with every part of it. 
A glass tube was then used, one end of which communicated with 
the air in the vessel and the other end was taken into the mouth, and 
in this manner the air highly charged, was inhaled, without suffering 
any of it to come in contact with the skin. Upon examining the 
urine an hour and a half after this inhalation had taken place, it was 
found imbued with the smell of violets, and the smell was still 
stronger a few hours afterwards. 

Similar experiments were made with various other substances — as 
Camphor, a strong infusion of Garlic, a decoction of Asparagus, 
without any test being discovered of their absorption by the skin. 
These experiments, may be regarded as very nearly if not entirely 
decisive, and they clearly disprove cutaneous absorption in the healthy 
and undisturbed cqndition of the skin. 

Besides, the structure of the skin is opposed to such a belief. For 
while it is admitted that the exhalents of the skin pierce the epi- 
dermis, and come in contact with the external air, the mouths of the 
absorbents terminate under it and are covered by it. By examining 
the skin with a microscope, it is discovered to be of a squamous tex- 
ture, resembling in its arrangement the scales of a fish, and it is under 
these scales that the mouths of the absorbents commence. While it 
remains unirritated and entire" no absorption takes place. When ab- 
sorption does take place, the article must be forced by mechanical 
irritation under the epidermis ; and it happens that in particular parts 
of the body where the skin is thin and delicate, as the inside of the 
arms and axillae, the thighs and genitals, absorption takes place very 
readily ; or where this is not done, the epidermis has been destroyed' 
by injury or disease — or if sound, the article is of an acrid nature, 
which first erodes the tegument and comes in contact with the mouths 
of the absorbents. 

The experiments of M. Seguin confirm the above opinion. He dis- 
solved in the water of the bath in which he made his experiments, 
substances which produce a specific effect upon the system, by which 
absorption might be ascertained. He employed the Per chloride of 
Mercury, in solution, on a number of venereal patients, and while the 
epidermis was entire, he never perceived a single instance of saliva- 
tion, or even amendment to their complaints. But when the epidermis 
was destroyed, as in ulcers or the itch, the specific effects of mercurv 
4 



XXVI. 

on the system were soon produced. It is unnecessary to state that the 
doctrine of cutaneous absorption is a subject of doubt and discussion 
among physiologists, many still asserting that it does take place. 
In a note to Meckel's Descriptive Anatomy, it is even stated that 
Lauth, Jr. has succeeded in injecting the cutaneous lymphatics with 
quicksilver ; but as no details have been been furnished, neither has 
the work reached this country, I have not changed the opinions I 
have delivered on this subject. These opinions have been confirmed 
by those of Beclard in his Descriptive Anatomy, who observes, that in 
the experiments and observations in favour of this absorption, it may 
have taken place by respiration as well as by the skin. In other 
cases in which the epidermis has been softened, altered, or abraded 
by continual applications to its surface, or repeated rubbings, absorp- 
tion is no longer cuticular, but of the same kind as that which takes 
place in the mucous membrane, or by inoculation, when the matter 
is carried through the divided epidermis into the corpus mucosum, 
and even into the dermis, both parts being eminently absorbent. 
When this is done, there remains a small number of facts which 
show, that certain substances are absorbed by the skin through the 
epidermis in its entire state, but that this membrane is truly an ob- 
stacle that very often prevents the absorbent power of the external 
tegument. 

Having shown that the supposition of absorption by the skin in a 
natural state, and the effects upon the system which were derived 
from this source, were gratuitous, it remains for me to point out in 
what manner impressions attributed to this source, are communicated 
to the system. These, as I have already hinted, are in some degree 
by the lungs, but they are also in a very conspicuous manner by the 
olfactory nerves. The influence which these nerves exerted over the 
system, had been obscurely hinted at by former writers, and the prac- 
tice so general of applying amulets round the neck, and other customs 
among the common people may have had its origin in these opinions 
so vaguely delivered. To the industry and ingenuity of Dr. Rous- 
seau, we are indebted, for reducing to a certainty what was only 
speculation, and opposing by experiment what had formerly been a 
subject of conjecture. 

For this purpose, he employed a number of articles which were 
known, to produce the most unfriendly effects upon the system — as 
Tobacco, which we know when applied to the skin in the form of a 
cataplasm produces vomiting; Ardent Spirits, the fumes of which 
when inhaled produce intoxication ; and other articles of a like na- 
ture, could by a variation of his experiments either excite, or prevent 
these effects from taking place. 

In order to test the effects of Tobacco, a stout Irishman unapprised 
of the intention of this experiment, was hired for the purpose. His 
nose was made impervious with lint secured by adhesive plasters. A 
bath of a strong decoction of Tobacco having been previously pre- 
pared, he was put into it, and remained in it up to his navel for one 
hour and a half without evincing the least symptom of nausea, or 



XXV11. 

any other uneasiness, whereas the bystanders called to witness the 
experiment laboured under such a degree of nausea as to he put to 
the necessity of leaving the room, and some of them suffered from 
severe vomiting. A child seven years of age was plunged up to the 
neck, and remained in a bath of the same kind for two hours, his 
nose being secured, and suffered so little inconvenience that he ate 
cakes. 

A lady of a delicate constitution, extremely prejudiced against the 
smell of tobacco, having been repeatedly sickened by the breath of 
gentlemen chewing this vegetable, was induced to try the experi- 
ment. She first convinced herself, that when her nose was closed 
there was nothing nauseous. A quantity of tobacco leaves having 
been put into a large pan with a gallon of water over a chafing dish, 
and suffered to boil for some time, she breathed the fumes through 
her mouth, holding her nose with her fingers for half an hour, with- 
out experiencing the least nausea. Similar experiments were made 
with the fumes of Ardent Spirits, and the results were conclusive. 
The vapour from the liquor being inhaled for an hour or more with 
the nose secured, without any other sensation than a smarting of the 
throat occasioned by the fumes. The same experiment repeated the 
next day without the same precaution, for half an hour, produced so 
much giddiness that the person begged to be excused, declaring that 
he felt so giddy he did not think he could stand, and actually stag- 
gered in going to a chair. 

From these experiments we have strong reasons for concluding 
that the vapour of volatile substances, and of many other applica- 
tions which are made to the skin, instead of exerting their action 
through the organ, have their effects impressed upon the system 
through the medium of the olfactory nerves. These experiments are 
highly interesting in a practical point of view, as well as illustrative 
of the utility of many applications to the nostrils in common prac- 
tice—as volatile substance in syncope, and applying a handkerchief, 
or piece of fine cloth, or gauze, before the organs of respiration, when 
passing through swamps or other offensive places, so as to intercept 
insalubrious particles which are.mingled with the air breathed — since 
it is highly probable that it is from the impression of these particles 
upon the Schnciderian membrane of the nares, fauces, and also upon 
the delicate passages of the lungs, extended to the brain, that a 
foundation is laid for disease. 

The other surfaces to which medicines are applied will not at this 
time be considered separately, but will be treated of when speaking 
of the articles which act upon these surfaces, in the course of the 
Lectures. 

The consideration of the Modus Operandi of medicines would be 
incomplete, were I not to say a few words upon their sympathetic 
action, a subject so much enlarged upon by the Solidists.* You are 

* The Solidsits are that class of physicians, who refer all changes in the system 
to the immediate influence of the solidum vivum or living [solid. They are, as 



XXV111. 

aware that even at the present time Profs. Chapman and Caldwell 
have attempted to explain all the operations of medicines by the influ- 
ence of sympathy. After the details and experiments I have laid 
before you, the absurdity of such an opinion must be manifested. 
Still, however, I would not wish to be understood as rejecting the 
sympathetic actions of medicines, but on the contrary would state, 
that through this channel many of the changes which take place 
must be explained. I have already alluded to the subject, but before 
concluding will make a few other remarks. The origin of the term. 
The term sympathy is inappropriate in medical phraseology. It is 
itself a term of vague and indefinite character, and is more properly 
applicable to the interchange between mind and mind, than to im- 
pressions of a corporeal nature. It is used however in both senses, 
and in a medical point of view has reference to the changes occurring 
in parts of the body remote from each other, through the medium of 
the nervous system. That a connection exists in physiological rela- 
tion between the different parts of the system, numerous facts in health 
and in disease could be adduced. To enter into their details would 
be outstepping my limits, my province being to adduce examples of 
such medicines as have their actions exerted through this channel. 

The medicines which extend their influence to the system, by 
means of sympathetic connections, make an impression more or less 
considerable upon the part to which they are applied. They change 
at first the vital operations of the gastric organ, and give to the nerves 
of this part a new action, which is extended to the whole cerebral 
system. That such is the case, will be obvious by causing a person 
to take a portion containing Laudanum. The changes which I have 
represented as succeeding, are soon exhibited, and it is then that we 
observe spasmodic actions to subside which exist in remote parts. 
The medicinal substance makes an impression upon the surface 
which receives it, and it is this impression which excites the sympa- 
thetic actions. From this point it may be said to go out the changes, 
which are to be propagated to all other parts of the system. Effects 
similar in many respects may be said to attend the introduction into 
the stomach, of ardent spirits or other stimuli. A local impression 
being first produced, and this becoming extended through every part 
of the system. Upon similar principles we explain the action of 
Bark in arresting an approaching intermittent when given before the 
expected paroxysm, or Digitalis in speedily reducing the action of 
the pulse. Examples might be furnished from other classes. 

It is always to the cerebral and nervous systems that we should 
apply for an explanation of the transmitted impressions of medicines 
from one part to another. All new or unaccustomed impressions 
excited in the organs of the body, are extended to the brain, and from 
thence to the rest of the system. All the parts of this great system 

may readily be conceived, directly opposed to the Humoralists, and may be con- 
sidered as dating their existence as a distinct sect from the time of Hoffman, who 
flourished in the beginning of the eighteenth century, 1730. 



XXIX. 

have an intimate relation — the brain with the spinal marrow and 
ganglions, these with each other, and through their diversified rami- 
fications with the whole organized structure. Strictly speaking, 
therefore, every article taken into the system, whether medicinal or 
otherwise, excites this extended chain of action, and therefore those 
attached to the doctrine of sympathy, might argue that any thing 
operates by sympathetic action. To maintain, however, that there is 
but one action common to medicines, i. e. Sympathy, is to contend 
against all the discoveries which have been made in physiology, in 
the action of the absorbents, and of the numerous facts which have 
been discovered on this subject, and not only betrays ignorance, but 
violates all the rules of true philosophy. 

When wishing to avail ourselves of the advantages to be derived 
from sympathetic influences, it is important to consider the extent of 
the impression which the agent makes upon the part of the body to 
which it is applied, and to study the relations which this part main- 
tains with the rest of the system. As every agent is not equally 
adapted to bring into action the play of the sympathies, so neither is 
every part of the body to which the agents are applied alike capable 
of exciting them. As I shall point out hereafter, some parts are infi- 
nitely better adapted for exciting sympathetic actions than others. 
Not only is the part to which they are applied of importance, but its 
condition should also command our attention. Thus when the sensi- 
bility of the gastric surface is enfeebled or torpid, the sympathetic 
effects of medicinal agents are less marked, and are produced with 
more difficulty. Is the same surface inflamed, and therefore more 
sensible? The sympathetic effects of medicines are more prompt 
and more intense. The condition therefore of the Gastric surface 
will modify very considerably the effects of our medicines, and should 
be carefully considered when they are administered. Destroy the 
sensibility of this surface, and the effects of our agents are alike de- 
stroyed. M. Dupuy has introduced into the stomach of a horse, after 
dividing or placing a ligature upon the eighth pair of nerves, two 
ounces of Nux Vomica rasped fine, and made into a bolus, and no 
effect has been produced. The same quantity given to another horse, 
which had not undergone this operation, has caused death in a few 
hours, preceded by convulsions and Tetanic spasms. It is evident, 
therefore, that with medicines acting upon the nervous system, and 
with others which are absorbed before their effects are manifested, 
the actual condition of the vital parts to which they are applied 
must be considered of infinite importance. It is this which modifies 
the action of our remedies. Their impression is always the same; 
their operation would therefore be uniform, were there not counter- 
vailing causes chiefly arising in the state of the parts, to which they 
are applied, which renders feeble, partial, or inert, or violent, dan- 
gerous, or painful the means we make use of. Complaints are fre- 
quently made of the uncertainty of our remedies. Where they are 
of a good quality, their effects are the same. They are modified by 
the vital condition of the part to which they are applied, on the 



XXX. 

general system, — and the anxiety of the physician should be exhi- 
bited in studying their morbid conditions, and either adapting his 
remedies to the state of action, local or general, or adapting the con- 
stitution (a more difficult task) to the remedy. The former can only 
be obtained by a knowledge of the pathological derangements which 
are caused by the disease, or connected with it, and which can only 
be acquired by the study of pathological anatomy — and the latter by 
attending to the various indications pointed out by the pulse, the 
temperature, the secretions, the sensations, etc. 

References. — Barbier's Traite Elementaire ; Currie's Medical 
Reports; CaldweUs Theses; Cyclopedia of Practical Medicine. 



Upon the Advantages to be Derived from a Combination 
of Medicines. 

The present subject is as important as any that will be brought 
before you, but it is one upon which little has been written. The 
ancients have left us scarcely any thing ; and it is here and there 
only, that it is alluded to, without any definite directions, or any 
reasons assigned for combinations of this nature. The attention 
which has been paid to this subject is altogether of modern date, 
and though something was done during the close of the last century, 
in a very interesting paper by Dr. Fordyce, to arrange and sys- 
tematize which had been furnished by experience and observation, 
yet it is to the exertions of a very recent writer, Dr. Paris, that the 
few and scattered principles which were known, have been collected 
together, and with the aid of genius been made to assume a scientific 
form. It may be matter of some surprise, that such an undertaking 
should have been reserved for this period ; and abknowledging as we 
do, the beneficial operation which results from a union of medicines, 
that such facts as were known, should only now have been embo- 
died. I am at a loss to assign any reasons for this neglect, particu- 
larly as the combination of medicines has for a very long time been 
practised. The prescriptions of the ancient physicians which have 
come down to us, contain a great number of medicines united toge- 
ther. Of this nature was the celebrated Theriac and Mithridate 
remedies which contained from forty to sixty ingredients, and which 
were supposed to be efficacious against poisons and a great variety 
of diseases. 

The Theriac is still employed by the French physicians. The 
general composition consists of a mixture of excitant with narcotic 
substances, in the proportion of a grain of the latter to, a drachm of 
the compound. It is directed in doses of x. xx. or xxx. grains, as a 
gentle stimulant to the organs of digestion. It is thus employed as 
a Stomachic, and is also recommended in diarrhoeas, dysenteries, and 
in colics. 



xxxi. 

The Mithridate in Pharmacy was a composition in the form of an 
electuary. It was formerly a capital medicine in the shops of the 
apothecaries, being composed of a number of drugs, among which 
were opium, myrrh, ginger, saffron, cinnamon, etc. It was considered 
cordial, opiate, stimulant, and alexipharmic. It takes its name from 
Mithridates, king of Pontus, who is reported to have so fortified his 
body against poisons, with antidotes and preservatives, that when he 
had a mind to despatch himself, he could not find any poison that 
would take effect. The recipe of it was found in his cabinet written 
in his own hand, and carried to Rome by Pompey. 

These articles are not mentioned for their utility, but to illustrate 
the extent to which medicinal combinations were practised. 

The same disposition seemed to have existed among the Romans, 
as may be seen by referring to Celsus, and to have been extended to 
the Arabian physicians. The practice was continued even to the 
last century, and we find in the writings of Dr. Huxham, a great 
variety of articles united in one formula, and some of his prescriptions 
are extant, which contain from one to two hundred ingredients. The 
utility of such multifarious compounds has been so much doubted 
within the last few years, that we may be considered as having gone 
into the other extreme, and instead of mixing medicines, have been 
often satisfied to exhibit them singly. The purport of these remarks 
will be to show, that by combining medicines, the energy of our 
practice can be much increased, (not but that many indications may 
be fulfilled by employing single substances,) but by uniting them to 
a proper extent, greater activity will be afforded by the compounds, 
not otherwise possessed, and in some instances we may give rise to 
remedies of entirely new powers. Dr. Ferriar observes, that though 
it may appear fanciful to many persons, yet be has been led by ob- 
servation to suspect, that there exists in the relative effects of medi- 
cines, something similar to the harmony of colours and sounds ; and 
that the impulse requisite to the living powers of the body, which 
cannot be produced by a single impression, may be afforded by a 
concurrence, or succession of impressions, in some degree dependent 
upon each other. * 

The division which I shall make in treating of this subject will 
be, first, to consider the benefits derived from the union of Substances 
of a Similar Nature, and then, the benefits from the union of Sub- 
stances of a Different Nature. Before proceeding to treat of either 
of these divisions, it may be proper to consider what is the constitu- 
tion of a formula consisting of more than one article. In every 
compound formula we distinguish, most commonly, a base, an auxi- 
liary, a corrective, and a form, under which it is exhibited. By the 
base or basis, is understood the medicinal substance which prevails 
in the formula — that of which the action is principally remarkable, 
which excites the physiological phenomena in a manner most appa- 
rent, and which in short distinguishes most of the effects which 
follow the use of the medicine. To determine the ingredient which 
forms the base of a pharmaceutical preparation, we are not to con- 



XXX11. 

sider merely the bulk or the dose of the medicinal substances which 
enter into its composition; but the comparative activity proper to 
each of them. Often the substance which enters into the mixture in 
the proportion of a few grains is the base, because it gives energy to 
the action of the other substances, and ft is to its influence that we 
perceive the effects derived from the mixture. 

The Auxiliary is a substance mixed with the formula to augment 
the activity of the base, to give more intensity to the effects which it 
is capable of exerting. The auxiliary ought always to conform in 
its properties with the principal ingredient of the compound in which 
it enters.- It is necessary that their impression upon the vital organs 
should be of the same nature and have the same character, that join- 
ing its action to that of the base, it may give to the medicine more 
extended and important effects. 

The Corrective, or corrigens, is an ingredient in a pharmaceutical 
compound, which has for, its office to moderate the too great activity 
of the medicinal substances, among which it is placed. It becomes 
necessary, when these from their action are likely to produce unplea- 
sant effects, or when carried too far would prevent the intended action, 
and defeat the objects of the exhibition. The last circumstance is the 
form under which the medicinal substances are best exhibited. 

The prominent features of every compound formula being thus 
noticed, I shall proceed, first, to consider the advantages derived from 
the union of substances of a Similar nature. That a union of these 
substances gives greater activity to the compound than they pos- 
sessed in their single state, is proved in a variety of instances. We 
will consider the effects of this union in promoting the action of Pur- 
gatives. All purgatives have not the same effect, though they all 
produce more frequent and more copious evacuations from the intes- 
tines than take place in health. Let us examine into the manner in 
which the differences of their operation may be so united as to result 
in the formation of a more useful formula. For example, Sulphate 
of Potash, or Soda, or Magnesia, operate more quickly than Aloes, 
Rhubarb, or Jalap. These last medicines, however, occasion an eva- 
cuation of fceculant matter, while the forrner most commonly occasion 
discharges of serous fluids. If an evacuation is wanted sooner than 
would take place from employing aloes, rhubarb, or jalap, at the same 
time an evacuation of fceculent matter, it would evidently be better 
to mix any of these saline preparations, with the rhubarb, jalap, etc. 
than to use the last alone, or either of the salts alone. " Such a mix- 
ture is, therefore, found to produce a quicker evacuation, and at the 
same time a more fceculent one, than when any of these medicines 
are given separately. That such is actually the case, the experience 
of every practitioner testifies, and many will concur with me in the 
beneficial operation of the Sulphate of Potash, (as being more agree- 
able than the other salts,) in conjunction with Jalap or Rhubarb. By 
this union the action of the Jalap is quickened, its griping tendency 
obviated, and a smaller quantity of the substances is sufficient. This 
example will furnish ns an instance of the basis of a prescription and 



xxxm. 

its auxiliary. The Jalap being the more active article, is entitled to 
the former consideration; the salt is the auxiliary, as it augments 
the activity of the base. Similar beneficial effects result from the 
union of Jalap with Calomel — of Senna with Salts. It is upon the 
union of several articles of a similar nature that we explain the acti- 
vity of sea water, of several mineral waters, as the sum total of these 
ingredients in a given quantity being much smaller than we should 
have supposed. Sea water and mineral waters owe their activity to 
the number of ingredients they contain in connection with their free 
dilution. The proportion of the active articles is so very small, that 
it is only by their combination that their peculiar effects take place. 
Gamboge combined with Aloes, forms a compound exempt from the 
objections arising from the too rapid solution of the one, and the 
slowness of the solution in the other. In like manner combinations 
of Rhubarb and Sulphur, or other articles, are more effectual in keep- 
ing the bowels free of feculent matters in fevers, than either of them 
exhibited singly. These examples may be extended, and doubtless 
your experience will suggest to you the beneficial effects of a union of 
medicinal forms as pertinent as any I have mentioned. The remarks 
offered are applicable to laxatives, and equal advantage arises from 
mixing several of them together. When one laxative is employed, 
and in a sufficient dose, it is apt to produce sickness and pain in the 
bowels, and it is uncertain in the degree of its operation. When 
several are mixed together, they are much less apt to produce these 
effects, and are much more certain in their operation. For instance, 
Manna, when given alone in a sufficient dose, produces considerable 
sickness and uneasiness in the bowels, excites colicky pains with a 
disposition to acescency — yet combined with Senna, Cream of Tar- 
tar, or the Sulphate of Magnesia, it forms a pretty active and by 
no means unpleasant medicine. The truth of these observations is 
strongly illustrated by the following combination: — 12 drachms of 
Cassia pulp are equivalent in purgative power to 4 ounces of Manna ; 
yet if we give jviii. of the Cassia pulp with giv. of Manna, we obtain 
double the effect of a full dose of either. — Paris' Pharmacologia. 

From the tenor of these remarks it is obvious, that a union of seve- 
ral similar remedies will produce a more certain, speedy, and consider- 
able effect than an equivalent dose of any one. This is so uniformly 
the case that it is established as a law in relation to pharmaceutical 
operations. We will consider its application to other classes of medi- 
cines. Among Emetics, we will find that the union of Ipecac, with 
Tart. Antimon. affords a more efficient medicine than either alone. 
Ipecac, more certainly produces vomiting than Tart. Emetic, the latter 
not unfrequently passing downwards and affecting the bowels; by 
mixing them, therefore, the certainty of emesis is secured, while from 
the greater energy of the antimonial preparation, more copious dis- 
charges are produced, and a crisis of the disease more speedily effect- 
ed. In like manner in cases of poisons being swallowed, it is better 
in order to produce vomiting quickly to mix the Sulphate of Zinc 
and Ipecacuan than to employ either of them alone. The Class of 
5 



XXXIV. 

Tonics will furnish us many illustrations of this law equally satisfac- 
tory. Medicines of this class, as the cinchona, cascarilla, the seve- 
ral species of Carduus, chamomile, the rinds of fruits of the orange 
kind, the gentians, and many others, agree better with the stomach 
and tend more to strengthen the system when mixed together, than 
when any one of them is employed. The utility of this practice 
seems well established, though we are at a loss to explain the changes 
which take place among the medicinal compounds. 

I shall detain you with one other example of the utility of a combi- 
nation of substances of a similar nature. The instance to be adduced 
is among that class of medicines called Alteratives. The articles 
belonging to this class are possessed of properties very analogous, 
being stimulating, subtonic, and diaphoretic. They are very nume- 
rous, and are resorted to in protracted affections, in impaired conditions 
of the system, in obstinate ulcerations, and local diseases generally. 
They are termed Alteratives, since from their long continued Use they 
seem to alter the condition of the solids and fluids, and by their tonic 
impressions improve the vital energies, and promote the process of 
secretion in the various parts of the body. ' 

The articles of this class are not only derived from the Vegetable 
kingdom, but some of the most powerful are obtained from the Mi- 
neral. This class of medicines I have had frequent opportunities of 
employing, and consider them very valuable additions to the Materia 
Medica. Useful as they are occasionally found to be when given 
separately, from repeated trials I am satisfied that their good effects 
are greatly increased, and rendered more certain by combination. 
Upon this, principle some of the oldest and most popular formulae 
have been established, as the Lisbon Diet Drink or Compound De- 
coction of Sarsaparilla, the Syrup of Sarsaparilla as given in the 
French Codex, and the Sirop de Cuisinier. To which I may add a 
preparation originally made in imitation of Swaim's Panacea, but 
which I have found to possess properties much superior, and the par- 
ticulars of which I shall relate at a future period. 

The remarks I have made, apply to the union of articles of the 
Vegetable kingdom, but they are rendered more striking by uniting 
those of the Vegetable and Mineral kingdoms. Swaim's Panacea 
owes its efficacy to the union of vegetable and mineral alteratives, 
since it has been found to consist of. Corrosive Sublimate or Perchlo- 
ride of Mercury, added to a concentrated decoction of Sarsaparilla 
and other alteratives. 

The observations which have been made upon these classes, might 
be extended to all the rest of the Materia Medica. 

It should be observed, howevejr, that through the application of this 
law, that of uniting articles of a similar nature has been advocated, 
and its utility supported in a variety of instances, yet it is only de- 
signed that it should be practised within moderate limits. By multi- 
plying these ingredients to an unreasonable extent, we would, instead 
of rendering the compound more agreeable to the stomach, excite 
disgust, and "so reduce the dose of each constituent as to fritter away 



XXXV. 

the force and energy of the combination." Before concluding this 
division, I will further illustrate the utility of the principles, by a very 
familiar example, furnished hy Dr. Fordyce. In the preparation of 
food, when the object is to make the stomach bear a large quantity, 
without exciting sickness by adding spices to if, it has been the uni- 
form practice of all nations never to employ one spice alone, when 
two can be procured, and even to mix a greater number together. 
Pepper alone, ginger alone, cinnamon alone, garlic alone, or any 
other spice or stimulant alone, would not render any kind of food 
capable of being retained in the stomach and in so large a quantity, 
as when these spices or stimulants are mixed together. 

The second division of my subject consists of the union of sub- 
stances of a different nature. A combination of medicines of this 
description, though the principles upon which they are regulated are 
more obscure, furnish us with the best formulae for contending with 
disease, and for alleviating distressing symptoms as they exist. They 
are often extemporaneous in their formation, and many of the most 
favourite compounds have been the result of accidental mixtures, 
originating in particular states of disease, or the experience of the 
individual. Combinations of this nature enlarge and extend the sphere 
of our remedial operations, and are subservient to many useful pur- 
poses. 

1. They enable us to contend with several symptoms of a disease, 
or produce two or more different effects at the same time, in a manner 
which is not oppressive to the patient. 

2. They are further useful in promoting the operation of particular 
medicines. 

3. They, in some instances, give rise to compounds of entirely new 
forms. 

These beneficial effects are both illustrated by particular examples. 
Under the first head I would observe, that in cases of severe diarrhoea, 
where the object is to check the morbid discharges from the intes- 
tines, at the same time to relax the vessels of the surface, we combine 
an astringent and diaphoretic medicine. In this case we may employ 
Tormentil, or Kino, or other article to act as an astringent upon the 
intestines, and small doses of Ipecac, to relax the vessels of the skin. 
These two operations being accomplished, the disease readily yields. 
We effect the same object by the administration of the Dover's Pow- 
der, which is probably as useful a compound as could be selected in 
this particular disease. The Opium in this instance often exerts an 
astringent joined to an anodyne operation, and the nausea excited by 
the Ipecac, tends strongly to divert the current of morbid action from 
the intestines to the surface. 

Another instance of the same mode of action, is the once much 
famed composition of Dr. Moseley, called the Vitriolic Solution, which 
consisted of the Sulphate of Alumina and Potash, and the Sulphate 
of Zinc ; their combined operation resulted in a diminished secretion 
from the bowels, and an increased discharge from the surface. The 
utility of combinations with a view to produce two or more effects, is 



xxxvi. 

illustrated in cases of severe spasm of the bowels. When the object is 
to lessen pain and muscular contraction, and to excite free discharges 
from them, the union of Opium with Calomel in large doses, in such 
cases is more beneficial than any remedy which is employed. In 
the treatment of Dropsies we have often two indications to fulfil — 
to evacuate the water, and to support the strength of the patient. 
Hence the necessity of combining stimulating cathartics with active 
tonics ; and under these circumstances I have often derived great ad- 
vantage from the union of the Crystals of Tartar with an infusion of 
Quassia Wood. In the same disease, when it has been of long dura- 
tion and depleting remedies become necessary, stimulants are required 
to support the system under their operation. Here a solution of Gam- 
boge in Sulphuric iEther will be found to promote our intentions 
very fully. 

These examples illustrate the point under our consideration, and 
though their number might be increased, and the practical benefits 
derived fVom a more extensive combination pointed out, yet other 
objects remaining to be brought to your view, I can only allow to 
myself a rapid survey of the whole. I regret this the less as these 
examples will be presented to your notice at a future period. * 

2. The next advantage derived from the union of different medi- 
cines, is the change which takes place in their composition by which 
their operation is promoted. This change consists often in an increase 
in the solubility of the substance by the vital energies of the stomach 
and intestinal canal ; and it is probably owing, Dr. Paris observes, to 
the diversity which exists in the solubility of the active elements of 
purgatives, that so great a difference occurs in their operation. To 
this it is owing that some cathartics operate as emetics, and that 
others exert but little action upon the small intestines, but have their 
whole force expended upon the colon and rectum. It is probably 
owing to this circumstance that some articles are more liable to pro- 
duce griping, and other uneasiness in the bowels, from the principles 
of their activity refusing to be softened, or otherwise acted upon by 
the energies of the primse vise. From the foregoing I would inquire, 
whether many substances now considered inert may not be rendered 
active, and the activity of others increased, provided more attention 
was paid to medicinal combinations? The subject is obscure and still 
in its infancy ; but it will always continue in these states, provided 
the intimate mixture of medicines and their effects are not more 
attended to. I cannot but hope this notice will not be lost upon you. 
That the insolubility of medicinal substances is changed by a union 
with others, a few examples will sufficiently illustrate. Aloes, which 
we know passes through the bowels, and exerts its action upon the 
rectum, has its solubility increased, and its powers of action quick- 
ened, by being combined with Gamboge. The purgative property 
of Senna, residing in a bitter extractive matter, which is compara- 
tively insoluble, and on that account probably liable to produce grip- 
ing, has these effects corrected by being combined with Salts, or an 
Alkaline Salt. Infusions of bitter vegetables have their virtues im- 



XXXV11. 

proved by the addition of Soda or Potash, which operate by rendering 
the bitter principles of more easy solution and consequently more 
efficient. 

3. The last of the objects to be considered in the combination 
of medicines, is the formation of compounds of entirely new powers. 
This is effected either by a mixture of such substances as exert an 
antagonizing operation upon each other, or it is the result of chemical 
actions, altering and newly blending the different principles of the 
compound. As an instance of the first, I would mention, that the 
preparation usually called Dover's Powder affords an example of the 
union of two substances producing effects different from either. The 
narcotic operation of the Onium is obviated by the tendency of the 
Ipecacuanha to produce relaxation of the surface ; and the diapho- 
retic operation of this last, is augmented by the stimulus of the 
Opium giving excitement to the action of the heart and arteries — 
the result, therefore, is a diaphoretic of great power and extensive 
utility. As instances of the chemical actions producing new products, 
I may mention the change produced in colour, and properties, by the 
union of an alkali, as the Carbonate of Soda with Rhubarb — the 
formation of an Acetate of Zinc from the union of the Super-acetate 
of Lead and Sulphate of Zinc, a product supposed by many to pos- 
sess properties superior to either — the neutral mixture, as it is com- 
monly called, or the Acetate of Soda — the black wash formed by the 
union of Calomel and Lime-water. To these may possibly be added 
many important and interesting illustrations from a more extended 
knowledge of vegetable chemistry. Such are a few of the facts, 
which have been collected together, upon the subject of Medicinal 
Combinations. They are calculated, I trust, to direct the attention 
to its consideration in a greater degree, than has generally been done, 
and to prove in many instances the utility of employing compound, 
rather than' single prescriptions. These remarks become the more 
necessary, since in the view of the late Dr. Rush, but a very few 
articles were considered necessary to contend with every form of dis- 
ease — and that armed with Calomel, Opium, Tartar Emetic, and a 
Lancet, physicians could encounter all the ills to which flesh is heir. 

References. — Some Observations upon the Combination of Medi- 
cines, by G. Fordyce ; Paris' Pharmacologia. 



On Bloodletting. 

Previous to my entering upon the consideration of those agents, 
which, acting upon the several organs of the body, promote their 
secretions and thereby lessen the mass of blood, it may be useful to 
bring to your view the effects which are often derived by the imme- 
diate abstraction of blood from a vein. In this respect I shall be 
extending the list of agents commonly comprehended under the Ma- 
teria Medica. No apology is required for this innovation, as it has 



XXXV111. 

always been a matter of surprise, that in the various treatises upon 
this subject, comprehending the enumeration of the many remedies 
for controlling or modifying diseased actions, so important a remedy 
as bloodletting unquestionably is, should have been overlooked. Com- 
bining so many advantages, from the promptness of its operation, its 
effects upon the system, not only in abstracting from the quantity of 
the circulating mass, and a consequent abatement of activity in the 
sanguiferous system, but by the impression it makes upon the brain 
and nerves^ and upon the lymphatic vessels, it comes to be ranked 
among the most important of our remedies, the one which can with 
safety be appealed to in emergencies which threaten the overthrow of 
the animal fabric, or the derangement of its structure and functions. 
For these reasons I shall review the several states of disease in which 
it becomes applicable, with the circumstances and conditions of the 
system which render its employment safe and proper. It is only with 
the consideration of Bloodletting as a remedy that I shall endeavour 
to engage your attention ; the very interesting speculations upon the 
subject of the blood, with the manner of performing the operation, 
must be detailed to you from other chairs. 

The art of bleeding may be traced back to the remotest antiquity, 
and seems to have been common among the Egyptian, Arabian, 
Greek, and Latin physicians, even at a time when Anatomy had 
never been, or but little cultivated. The Greeks boast that Podali- 
rius, the son of Esculapius, was the first who practised bleeding, 
soon after the siege of Troy, and it is even probable that it was prac- 
tised before this period. How it came to be adopted, can not be 
known at this distant time. Pliny, indeed, supposes that physicians 
first learned this operation from having observed the Hippopotamus 
draw blood by pushing sharp reeds into its body. But this is very 
improbable, as there is but very little analogy between the artificial 
opening of a vein with a lancet, and the random wounding of an 
animal by friction against a broken reed. However the practice 
originated, mankind were soon convinced of its importance, and it 
has, I need not inform you, been continued with an increase of advo- 
cates to the present day. The most distinguished of these have been 
Botallus, De Haen, the celebrated Sydenham, Pringle, our country- 
man Rush, Dr. Armstrong, whose strong powers of reasoning place 
him in close alliance with the earlier recorders of disease, with many 
others who have added the tribute of their approbation to its beneficial 
operation. 

With these preliminary remarks, I shall proceed to the application 
of bloodletting to diseases. 

This remedy is undoubtedly the most direct means of diminishing 
the quantity of fluids in the system, and consequently of lessening 
the vital energies. To abstract that fluid, which is the immediate 
pabulum of life, cannot, it is obvious, be a matter of indifference to the 
constitution ; — if it be the most powerful means of influencing the 
vital actions, so it is the most dangerous when improperly employ- 
ed ; — if it is the most effectual mode of diminishing excitement, it is 



XXXIX. 

consequently the most apt to induce extreme debility. A cautious 
consideration of many circumstances is therefore necessary in deter- 
mining upon its propriety. These considerations become the more 
necessary, when the nature and character of disease are duly con- 
templated. They consist, for the most part, in certain determinate 
actions, which, unless early arrested, have a strong tendency to run 
their course. This is particularly the case with the febrile affections 
generally, and it is in such cases that the propriety or impropriety of 
bleeding is more especially manifested. 

Bloodletting, in its operation, is either palliative or curative, and is 
directed in disease as one or other of these objects is to be accom- 
plished. This distinction should be kept in view, particularly in the 
management of Febrile or Inflammatory affections. For the curative 
operation used in the commencement of these diseases, and carried to 
a considerable extent, the' subtraction of a large quantity produces 
such a change in the constitution as frequently to arrest the course 
of a febrile affection, or lay the case open to the action of other 
powers which restore health quickly and often completely. Thus 
employed, it has often been found extremely advantageous, and 
though the quantity necessary to produce this effect might often be 
thought dangerous, yet employed with judgment and discrimination, 
bad effects will seldom ensue. Indeed it is matter of surprise to what 
extent it may be carried in the concentrated forms of disease, particu- 
larly when the head is affected, without any ill consequences. In 
the Island of Barbadoes, Dr. Jackson asserts, that in the febrile affec- 
tions of 1813 and '14, the quantity abstracted at one time was rarely 
less than 3 pounds, frequently 4 or 5, sometimes 6. The vein was 
even sometimes reopened at a short interval, the blood allowed to flow 
to the extent of 4 pounds additional, amounting in all to ten pounds 
in twenty-four hours. It is unnecessary to say, that such practice is 
not generally advisable, and I am glad to say that it is not often 
called for ; but I have introduced it to show to what extent depletion 
by this channel can be practised, and in some forms how necessary it is 
to push it to the greatest extent, if we ever design to arrest the course 
of disease. To effect this object, one large bleeding is more beneficial 
than several small ones. Small bleedings diminish violence and avert 
the destruction of organic structures; they do not prevent the diseased 
action from proceeding through the regular process of what is termed 
coction, to a constituted period of formal crisis ; but as prevention is 
the professed and proper object of the physician, the decisive means, 
if they are at the same time the safe means, are those which ought 
to be adopted. — Jackson. 

The utility of this practice will appear upon a slight examination 
of the subject. Disease consists not only in increased, but disordered 
action. This action is not only exhibited in the increased celerity of 
the circulation, but this increased momentum of the blood, serves to 
produce still further disturbance in the action of the organic systems. 
By removing a portion of this fluid, we not only withdraw the means 
by which the impetus is afforded, but we abstract so much of a 



il. 

stimulating principle by which action is kept up. It is therefore 
properly preliminary of cure, or so prepares the way, that healthy 
action may be restored by other means. " The time when it should 
be employed with this view, is obviously of the utmost importance. 
If practised within six hours from the invasion, and before the disease 
has attained its acme — if conducted with the energy necessary to 
give effect to the purpose — the disease is either arrested, or is so much 
crippled in its progress that it readily yields to the means so com- 
monly resorted to, to restore the healthy train of actions. If practised 
later, its effects are less decisive but still salutary ; it is not to be de- 
pended upon, but it is not prohibited, and it is occasionally useful 
even at still later periods." — Jackson. 

The Palliative or Auxiliary operation becomes necessary, when 
the curative cannot be pursued. This practice, which is most fre- 
quently followed, is not without its advantages, and is particularly 
useful in conducting the disease to a safe issue. When employed 
before organic derangements have taken place, it is frequently more 
decidedly remedial, and more certainly beneficial, provided the powers 
of the system can sustain the operation, than any other single means 
we can employ. It is of this treatment I shall enlarge upon more 
particularly, and which I shall chiefly keep in view, in the present 
lecture. It is the least hazardous for those setting out in their career 
of practice, and until long experience has accustomed them to the 
various grades of action, tp be familiar with the phases of disease, 
and the capacity of the system to sustain strong and powerful im- 
pressions, the practice which I would recommend. It is time, how- 
ever, to enter upon the details of its employment to diseases. 

OF ITS UTILITY IN YELLOW FEVER. 

In this disease, the opinions delivered are more contradictory than 
could be desired ; but since unanimity cannot be obtained upon this, 
or any other subject, I shall consider the evidence of men who have 
been most distinguished in our profession. By Dr. Rush, and other 
physicians of Philadelphia, it was employed in conjunction with 
purging with very considerable success in the Yellow Fever of Phil- 
adelphia, in 1793. Its effects were beneficial in the highest degree, 
and he has described at length the obvious advantages which result- 
ed from it. These 'were, a reduction of the force and frequency of 
the pulse, checking in many cases the vomiting which occurred in 
the beginning of disease, and lessening the difficulty of opening the 
bowels. It removed delirium, coma, and obstinate wakefulness — les- 
sened muscular debility, and eased pain. In particular it is stated, 
that when used early on the first day, it frequently strangled the 
disease in its birth, and generally rendered it more light, and the 
convalescence more speedy and perfect. It should not, however, be 
indiscriminately employed, but judgment and care be exercised, and 
the practice pursued only in the early stages. It is probably owing 
to inattention to the stages, that the contradictory accounts upon 
this subject have originated, since it is obvious, that the earlier it is 



xli. 

employed in a disease which runs through its course with so much 
violence and rapidity, the more beneficial will be its effects. Dr. 
Jackson speaks of its great utility under these circumstances. Drs. 
Moseley and Pinckard are equally favourable to this practice when 
similarly pursued. 

As far as I can judge of the utility of bleeding in this disease, it 
would appear, that when the sick were visited early after its acces- 
sion, that when the subjects were of a robust habit, such as is the 
case with foreigners previous to their being climatized — that blood- 
letting was undoubtedly of considerable utility. Under these circum- 
stances, it diminished the turgescence of the blood vessels, moderated 
the action of the heart and arteries, controlled the unequal distribu- 
tion of the blood in the several parts of the body, and, by lessening 
the excitement of the brain, tended strongly to the relief of its sym- 
pathetic derangements — as gastric uneasiness, muscular pains, with 
the distressing restlessness, and jactitation of the patient. In some 
instances, a speedy crisis of the paroxysm ensued, and in all great 
relief was afforded. Carried to the extent of producing faintness, by 
suddenly diminishing the excitability of the system, the various se- 
cretions were renewed, and the patient has fallen into tranquil and 
refreshing sleep. It is not to be supposed that a cure is to be effected 
by this means only, but along with it, depletion by the bowels, and 
the full exercise of the antophlogistic treatment. 

The quantity of blood to be drawn in this, and other diseases, with 
the frequency of the repetition, will depend upon a variety of circum- 
stances and the judgment of the practitioner. It will be connected 
with the temperature of the weather, the strength of the predisposing 
causes, the constitution of the patient, and other considerations which 
can better be determined by an inspection of the case, than by a de- 
scription. In this and nearly all acute diseases, it should be carried 
to the extent of producing a positive impression — as it is only from 
the cerebral and nervous energies being reduced, that beneficial effects 
can result. When the remedy is employed to this extent, it will be 
found productive of more decided advantages, than any other eva- 
cuation. 

Where the state of excitement forbids the employment of venoese- 
tion, its topical abstraction is highly to be recommended. Of the 
consequences of fever, none are more striking than the unequal dis- 
tribution of the fluids, with the state of oppression of particular 
organs. The brain and nervous system, are particularly and vio- 
lently affected in this disease, and doubtless many of the symptoms 
which are exhibited in the progress of the complaint, have their ori- 
gin, in the strong and unequal conflict which this organ sustains. 
Lessening these determinations by cupping, or what is preferable, by 
opening the temporal artery, and allowing a free evacuation of blood, 
the action of disorganization is arrested, and great and effectual relief 
is afforded. I have on several occasions where general depletion by 
the lancet has been inadmissible, had recourse to this local detrac- 
tion of blood, and always with the happiest effects. In dismissing 



xlit 

this subject, I shall repeat, that it is to the earlier stages of the 
disease that it is best adapted, though circumstances may occur in 
its progress which will render it useful. The time, I repeat, when 
bleeding is performed in this and other diseases, is obviously of the 
utmost importance. The physician, in the first stage of fever, armed 
with his lancet, is, in the language of S. Smith, to his patient what 
the fireman with his engine, before the flames have had time to kin- 
dle, is to a building that has taken fire. At this early stage, the 
former can check inflammation with almost as much ease and cer- 
tainty, as the latter can prevent the flames from bursting out. While 
the physician, who is called to treat inflammation in the latter stage 
of fever, is in the position of a man, who arrives with the apparatus 
for saving the house, when its stories have been already consumed, 
and its roof has fallen in. 

As may be supposed, in the Simple Continued, Intermitting, and 
Remitting forms of fever, bleeding is often required ; and in the latter 
particularly it may be found necessary to begin with opening a vein, 
and to repeat the bleeding, according to the urgency of the symptoms. 
The operation may be performed during the remission, though it is 
better in the height of a paroxysm, and the remission is observed to 
come on sooner and be more complete. - The earlier, too, in the dis- 
ease it is performed, the better, as by a prompt and efficient use of the 
remedy, the progress of the disease may be arrested, and this with 
greater probability of success, as the disordered condition of the vas- 
cular system has existed but for a short time. The pulse should be 
observed sensibly to yield to the evacuation, the blood being allowed 
to flow until it becomes feeble, small, and a disposition to faint, or 
actual fainting, be produced. By this method of proceeding, its open 
character is subdued, and with it the constitutional affections — or its 
concealed dispositions made manifest, and thus readily point out the 
means to be pursued. When bleeding is delayed to a more advanced 
period, more caution should be observed, for though the morbid ac- 
tions may be reduced, the powers of the system may be so prostrated 
that reaction will become impracticable, and the remedy, from being 
ill-timed, become more destructive than the disease. 

In Remittent Fevers, complicated with determinations to the He- 
patic system, the remarks which have been made upon Bleeding in 
fevers generally, are particularly applicable. 

This is a very common form of fever, in the low and marshy dis- 
tricts of our country, and is familiarly known by the name of Country 
Fever. In these cases, I believe that the use of the lancet in the 
beginning of the disease is of the utmost importance : — not only its 
early, but sometimes its free use during the disease. By an early 
recourse to it, the severity of the paroxysm is much mitigated, and 
if carried to the extent of reducing the pulse, or disposing to syncope 
a copious secretion from the surface is produced, with great and 
essential relief to the symptoms. By it we obtain relief of many 
symptoms, as headache, irritable stomach, restlessness, pains in va- 
rious parts. By it the action of cathartic or other medicines is 



xliii. 

promoted, and by it also those determinations, and organic derange- 
ments prevented, which so often render the cure imperfect, rendering 
the life of the patient a continued struggle to produce health, or 
obviate disease. 

The effects of bloodletting, I would wish to observe in this disease, 
(for it may be the only opportunity I shall have to offer my views 
of treatment,) are very powerfully supported by the affusion of cold 
water. The adoption of this practice, seems as a substitute for con- 
tinued bleedings, without its exhausting effects. A proper employ- 
ment of it reduces the pulse 10 or 20 pulsations the minute, lowers 
excitement of the skin, relieves pain, and counteracts determinations 
to particular organs. It removes delirium, tranquillizes the patient, 
induces sleep, and promotes many of the secretions, particularly of 
the skin. A single effusion is, however, not sufficient, but it must be 
continued every two hours, or oftener as the excitement demands. 
Thus pursued, I have had a patient immersed six or eight times during 
the day, and with the most delightful effects. In short, my direc- 
tions are, to place a large bathing tub in the room, and require of the 
attendants to place the sick person in the bath whenever the excite- 
ment rises ; whenever he complains of heat, restlessness, confusion in 
the head ; whenever there is muttering or other symptoms. 

Manner of using the cold effusion. — With these means, evacuants of 
a mild character are to be employed ; they are generally saline, com- 
bined with an infusion of Serpentaria or Senna, and so administered that 
six or eight evacuations are obtained in the twenty-four hours. By 
these simple remedies, continued perseveringly, the utmost relief is 
afforded, the progress of the disease greatly mitigated, convalescence 
is proportionably rapid, and since its adoption I have not to my recol- 
lection lost a single patient with country fever, as it is called. 

Medicines administered at intervals of two or three hours, are not 
sufficiently prompt to contend with the disease. Strong impressions 
are required, to 'prevent those derangements of particular organs from 
taking place, which result in congestions, and particularly those con- 
gestions of the brain, which are so often exhibited in the concluding 
stages, and which when established, all the stimulants which can be 
applied, are insufficient to overcome. Hence the patient sinks, not 
because the stimulants are not sufficiently powerful, but because the 
brain has sustained such lesious from previous excitement, that its 
energies cannot be renewed. It is to prevent these derangements, in 
the early part of the disease, that the practice I have recommended 
should be directed. 

It is, however, in Inflammatory diseases and affections, properly so 
called, that the great superiority of this remedy is manifested. Here 
the blood vessels chiefly are disordered, and the evacuation is made 
directly from them. The impression, therefore, can be more instan- 
taneous, and its action extended at once to the seat of the affection. 
In these cases it will be obvious, that the earlier it is employed, the 
better, especially in affections of the chest and abdomen, where from 
the great vascularity of the parts, the progress of the inflammatory 



xliv. 

action is extremely rapid, and the injury done to organs so essential 
to life often becomes irreparable. Here, then, the importance of atten- 
tion to time is apparent, and it illustrates the propriety of this direction 
in the former diseases. But this is not the only direction which should 
be held in remembrance — the quantity which is drawn, and the sud- 
denness with which it is effected, are highly important. According 
as these are attended to, will be the strength of the impression made. 
The quantity to be drawn will depend upon the state of the pulse, the 
degree and seat of the inflammation, — the age, habit, and constitution 
of the patient ; but the effect m'ay always be increased by drawing 
blood from a large orifice, by abstracting a large quantity at the be- 
ginning, and continuing it, until the pulse is reduced, or a disposition 
to fainting brought on. By pursuing these directions, it has been 
observed that less blood was expended, than according to the usual 
method pursued of removing 10 or 15 ounces at a time — because (as 
Armstrong observes) one, two, or at most three, bleedings answered, 
whereas under the other mode, the operation has frequently to be 
repeated four or five times. 

By pursuing these directions, the temporary weakness is greater, 
but the patient gradually recovers, and his strength is restored to a 
certain degree. It is, therefore, best adapted to our views of fever, 
which are to reduce the present strong action of the arteries, without 
occasioning permanent weakness. We may obtain a positive effect, 
i. e. faintness and general relaxation, without exhausting the powers 
of life, by drawing blood while the patient is in an upright position ; 
and this practice may very properly be pursued with delicate consti- 
tutions labouring under high arterial excitement, or in cases where 
it is desirable to secure the consequences of free depletion without its 
exhausting operation. Let it, however, be distinctly understood, that 
in practising bloodletting, the effect to be obtained, or the impression 
made upon the system, is to be the measure of what is drawn, rather 
than the apparent quantity. This rule is enforced by the authority 
of Dr. Armstrong, and it is one which cannot too strongly be urged 
upon you. It will curtail the progress of inflammatory affections, 
and in most cases bring them to a speedy crisis. As there are few 
cases which will withstand two or three operations carried to the 
extent of producing faintness or fainting. It will save pain to your 
patient, and result in much satisfaction to yourselves. 

It may not be amiss to state some o£ the quantities which, during 
the existence of morbid excitement, the system will support without 
any ill effects being experienced. I witnessed a case of fever in the 
summer of 1 824, in which 4 pounds were drawn at once. > Mr. Cline 
drew 320 ounces in twenty days from a patient in St. Thomas' Hos- 
pital, London, who laboured under a contusion of the head. Haller, 
in his Elements of Physiology, has recorded instances of loss of blood 
which would appear incredible. From all that we can observe, it 
would seem that the system accommodates itself readily to the ab- 
straction of blood, and that it is quickly regenerated. — Vide Rush's 
Defence. 



xlv. 

It may be useful to bring before you some of the more common 
Inflammatory affections, in which the utility of bloodletting is mani- 
fested. In Pneumonia and Pleurisy, it is the remedy chiefly to be 
depended upon, freely and early employed. The directions which 
have been given should be fully attended to, and the quantity drawn 
be regulated by the degree of inflammation present, and the vigour 
of the constitution. In this disease, it is particularly proper to con- 
tinue the flow of blood until a remission of the pain takes place, or 
until a disposition to syncope is induced. We are not to stop the 
bleeding until one or other of these effects are produced. It will often 
happen, that with a reaction of the heart a renewal of the pain takes 
place. This is no proof that the remedy has been improperly used ; 
but on the contrary, a reason for repeating the operation, which in 
many cases may be done in a few hours, or on the same day. It will 
be particularly required, if syncope comes on from constitutional pe- 
culiarities, and before sufficient depletion has taken place. Under 
these circumstances a repetition of the operation will be better borne. 
The period during which the disease has existed will form no objec- 
tion to the practice recommended ; though it must be obvious, that it 
will be better borne, and the effects be more beneficial, according as 
it is done at an early period. But it may be practised at any time, 
only more caution is required, and a due consideration of all the cir- 
cumstances connected with constitution, age, etc. When general 
bleeding has been pushed to a proper extent without being beneficial, 
the local abstraction of blood, as will be mentioned, may properly be 
resorted to. 

In Dysentery, the utility of bloodletting is often very conspicuous. 
It is not to be understood that every case of this disease will require 
the practice here recommended, for it will often subside under very 
opposite practice. But when there is much inflammatory action, as 
evinced by an excited state of the arterial system, augmented heat, 
pain and soreness of the abdomen, with severe bearing down efforts, 
bleeding will be found of the utmost service, and this not only from 
the relief it affords, but by causing the system to be more readily 
acted upon by purgative medicines, shortening the disease, and les- 
sening greatly its tendency to become chronic. 

Of the utility of this practice, there is not wanting the authority 
of names in its support. Sydenham was a great advocate for bleed- 
ing in this disease, and Sir John Pringle frequently employed it in 
the dysenteries which appeared in the armies to which he was at- 
tached. It is not, however, the only means to be pursued, but a 
combined system of action must be adopted, in which, without avail- 
ing ourselves of any one remedy, the conjoint agency of others may 
be brought to our assistance. Premising, therefore, our management 
of acute cases of dysentery with bloodletting, we shall find its effects 
greatly supported by Cathartics, Opiates, Calomel, etc. 

In Phrenitis, arising from local injury of the brain, or unconnected 
with fever of any peculiar type, the advantages of bloodletting, or 
rather its superiority to all other means, are very conspicuous. Pur- 



xlvi. 

gatives, and even nauseating doses of emetic substances, are very 
important auxiliaries, but bloodletting has a more decided control 
over the symptoms than any other measures. In this disease, Vs. is 
therefore indispensable, and it is not unusual to observe every exacer- 
bation in the progress of such a case, denoted by increased restless- 
ness or delirium, together with an increased frequency of the pulse, 
of perhaps ten, fifteen, or twenty pulsations in a minute, regularly 
subside after the loss of even six or eight ounces. 

In Ophthalmia, the great importance of this species of depletion 
must be particularly obvious, as well as the necessity for early and 
decisive measures. 

The notice of this last disease furnishes me with an opportunity 
of pointing out and illustrating the utility of Vs. upon a very impor- 
tant system of vessels, — the Capillaries. No one can doubt the very 
important part these vessels perform in Inflammatory diseases — con- 
stituting the seat of inflammation. It must be obvious, that there 
is no course more effectual to take off the impetus of blood sent by 
these vessels to the head, to relieve vascular tension, and to deplete 
immediately from the diseased part, than the remedy of which I am 
speaking. 

The supply of blood sent to these vessels being diminished, as well 
as its impetus, these vessels, by their powers of contraction, are enabled 
to empty themselves by their own force, and by the same power to 
resist the return of an excessve load. In Ophthalmia we have exhi- 
bited to our view, the action which takes place in other parts while 
in a state of inflammation. The very minute vessels become enlarged 
and distended with blood, and to their excessive action the train of 
consequences which succeed are to be attributed. In this disease, or 
Ophthalmia, I have seen more benefit from a few ounces of blood 
taken suddenly, and a tendency to syncope brought on, in its removal, 
than by an active course of cathartics of two days continuance. In 
short, an inflamed eye, which is as red as scarlet before bleeding, in 
a few minutes is essentially improved in its appearance, and a repe- 
tition of the remedy will frequently remove it. From what has been 
said, the same remark will hold good in other inflammatory cases. 

There is yet one other form of fever in which the good effects of 
bloodletting are frequently manifested — the Puerperal state of fever. 
Different views have been maintained respecting the pathological 
character of this complaint, and much contrariety of practice has 
resulted. From an attentive consideration of the symptoms and ap- 
pearances upon dissection, little doubt can exist but that it is deci- 
dedly inflammatory. The pain, tenderness, fulness of the abdomen, 
the quick pulse, preternatural heat, headache, thirst and vomiting, 
with the post mortem examinations, strongly evince an active and 
malignant state of inflammation, extending with great rapidity from 
one order of parts to another. Under these circumstances, the treat- 
ment to be pursued consists in the exercise of the antiphlogistic reme- 
dies, and bloodletting is of indispensable utility. It should be drawn 
early, and freely, and the testimony of many distinghished practitioners 



xlvii. 

is decidedly favourable to its utility. Such, however, is the rapidity of 
the inflammatory action, and such the malignancy of its course, that 
it is considered unsafe to resort to this evacuation after the disease 
has been established thirty hours. The insidious nature of inflamma- 
tion is in no disease better exemplified than the present. It is often 
obscure in its beginning, insidious in its progress, and rapid in its 
termination ; hence it is apparent how necessary is a prompt recourse 
to bloodletting on the very first accession of the disease. For in 
many instances the continuance of increased vascular action for a 
very short time, places the patient beyond the reach of our remedies. 
A hesitating or undecided practitioner, who takes a few hours only 
to make up his mind respecting the course he is to pursue, may often 
thus doom his patient to an irretrievable fate. The importance, there- 
fore, of a thorough consideration of all the circumstances which 
should lead to so important an operation as bloodletting, cannot too 
sirongly be enforced upon you ; and this more especially, as there is a 
tact which cannot be inculcated by any rules, and is often, only to be 
acquired by actual practice and attentive observation. 

In thus considering the importance of bloodletting, as a remedy in 
the several forms of fever, I would not be understood to recommend 
it to the exclusion of other active remedies. Purgatives are excellent 
auxiliary means, and are of the greatest service in correcting the 
deranged state of the intestinal canal, which proves a source of irri- 
tation and keeps up the morbid actions. They often fulfil indications 
which bloodletting cannot, and are, therefore, not to be overlooked. 
I have wished to call your attention to the present remedy, which is 
probably too often neglected, and have endeavoured, through the 
whole of these remarks, to enforce its importance, its promptness, and 
its power in subduing morbid action. 

Objections have been urged against the lancet upon which it may 
not be improper to make a few general remarks. It has been urged 
against the practice, that Dropsies and Anasarcous Swellings are fre- 
quent consequences of its employment, and the dread of the disease 
has often operated greatly to the disadvantage of the patient. When 
these effusions succeed the attack of acute diseases, I am more dis- 
posed to think that they have oftener followed as the consequences 
of those diseases, for which it was necessary to bleed, than as the 
effects qf the remedies employed. They arise, as Dr. Rush observes, 
in most cases, from the want of sufficient bleeding in inflammatory 
diseases. And again, if ever bleeding kills, says Botallus, it is not 
from its excess, but because it is not drawn in sufficient quantity, or at 
a proper time. I repeat, therefore, that where these effusions arise, they 
rather proceed from our ill-directed efforts at, treatment, and from the 
diseased action being allowed to exhaust itself. Those means which 
are best calculated to subdue this action, are the best adapted to pre- 
vent and cure such dropsical affections. In this manner we may 
account for the success attending the employment of bloodletting in 
those dropsies, resulting from the application of cold, or from other 
causes, when an inflammatory disposition exists. 



xlviii. 

Bloodletting has been objected to in fevers, as tending to increase 
the debility which exists. Every practitioner must be aware, that in 
cases of high arterial excitement the great apparent weakness arises 
from the oppression of the system from an overloaded state of the 
circulating vessels. (Whether or not the depression which exists pro- 
ceeds from the pressure of the blood upon the nervous fibrillce which 
are in contact through the whole system with the vascular ramifica- 
tions, and which pressure is occasioned by the increased action of the 
heart and consequent increased impetus of the blood — still the fact is 
evident.) Bloodletting, by relieving this state of the vessels, tends 
greatly to revive the strength and energies of the body, and this effect 
must have been frequently noticed. Cases no doubt exist, in which 
the powers of life are so much exhausted, that a single evacuation by 
the lancet would terminate fatally — but these cases can never be con- 
founded with those described. 

It has also been objected, that the practice of bloodletting renders 
its habitual employment necessary. For the refutation of this and 
other objections to the practice, I refer you to Dr. Rush's Defence of 
Bloodletting. 

The utility of bloodletting might be further illustrated by the recital 
of various other diseases, in which it is so much resorted to, and its 
efficacy so well established. These cases will be fully detailed to 
you by the professor of the practice, with the states of the pulse, and 
the appearance of the blood upon being drawn. My object s has been 
to call your attention to this mode of depletion, which is the most 
powerful practised — to enforce its operation in a few instances, and 
the extent to which it should be carried to derive its beneficial effects 
in the fullest degree. 

Before dismissing this subject, I shall briefly detail the immediate 
effects of this remedy on patients labouring under disease. 

The first is, a reduction of the force and frequency of the pulse. 
The pulse is more sensibly affected by this means than any other 
that is practised ; from being hard and frequent it becomes slow and 
soft. Of its influence in this respect many examples may be given, 
but I will only state, the pulse has been reduced from 112 pulsations 
in a minute to 64, and the effect so long continued, that at the expi- 
ration of iventy-four hours it did not exceed 84 pulsations. Its influ- 
ence on the pulse in other respects, is equally remarkable — from 
being small it gradually expands after the operation, when slow it is 
quickened, when strong and hard, it becomes soft. 

2. The sudden removal of delirium, is another effect which fre- 
quently succeeds this operation. 

3. The relief of pain, is another remarkable consequence of Vs. 
It is often so immediate that patients, after having been harrassed for 
a long time, have sunk into profound sleep soon after the arm has 
been tied up. 

4. It reduces the temperature of the surface by lessening the excited 
state of the circulation, and by inducing such relaxation of the surface 
as causes perspiration speedily to break out. With this change, the 



xlix. 

respiration becomes less hurried, the countenance becomes more clear, 
calm, and intelligent, and the sense of thirst is greatly abated. 

5. Bloodletting promotes the operation of cathartic medicines, in 
some instances so quickly, that the patients have demanded the close 
stool before the blood has ceased flowing. This effect of Vs. has 
been often noticed, and it has been resorted to with this particular 
view, in many instances with great advantage. 

The last effect I shall mention of the drawing of blood, is its ten- 
dency to induce sleep. The rest thus procured is often of the most 
grateful and refreshing nature, since it has not been obtained by such 
means as could harrass the patient with a train of morbid symptoms, 
but by reducing excitement, by lessening pain, and restoring the 
secretions to their usual state. The consequence is, he awakes re- 
freshed, invigorated, and his healthy feelings in some degree restored. 

Such are the more prominent effects of bloodletting. Without 
being an enthusiast I would inquire, whether such results have not 
been witnessed by every practitioner? If such is the case, how 
important are the benefits conferred, and how much more speedily 
will morbid excitement be reduced by this means, than by the wear 
and tear, as it were, of the intermediate organs, which other modes 
of practice not unfrequently produce ! Be cautious, and before hav- 
ing recourse to it, consider well all the symptoms and appearances 
presented to you, and you must be pleased with its effects. 

References. — Poliniere Sur les Emissions Sanguines; Armstrong 
on Typhus Fever ; Jackson on Fevers ; Welch on Bloodletting. 



Local Bloodletting. 

Under this division will be comprehended Leeching and Cupping. 

This method of drawing blood, I need not observe to you, is often 
attended with the happiest effects, and at the present time is very 
extensively employed in Europe, in the treatment of diseases. The 
researches of the French physicians, and the pathological opinions 
which have -arisen from them, has caused this local detraction of 
blood, and particularly by leeches, to be held in the highest estima- 
tion, and from this circumstance, in connection with the utility of 
the practice, your attention may properly be directed to them. 

Of the Genus Hirudo, there are several species, the principal, or 
that used in medicine, is the Hirudo Medicinalis. It is characterized 
by an oblong body, very contractile, having each extremity capable 
of being expanded into a fleshy disc, by which it adheres to the body 
with a kind of suction, similar to a cupping glass. A triangular 
mouth situated under the anterior extremity, armed with three very 
sharp, strong teeth, and a sucker at the bottom, by the assistance of 
which it draws blood from the wound it inflicts. 
7 



1. 

Leeches have for some time past been in use in the practice of 
physic, for evacuating the vessels of a part labouring under inflam- 
mation. Their employment, however, seems to be by no means so 
general, as their importance demands. This depends upon a variety 
of circumstances, chiefly the expense of obtaining them, in those 
situations where they are not to be had, or are of an inferior quality. 

It would be an endless task to enumerate the variety of medical 
and surgical cases, in which leeches may be used with advantage. 
In all inflammatory affections they are frequently of considerable 
service, but it is as an auxiliary rather than primary remedy. In all 
acute cases, and particularly of important viscera, general bleeding 
should be used to break the force of the disease, and after sufficient 
reduction, local measures are resorted to, to prevent a further expen- 
diture of the vital powers, and they act with peculiar advantage at 
this time on the part diseased. 

In inflammations about the throat, in the abdomen, thorax, cra- 
nium, or in the limbs and superficial situations, the benefit derived 
from the application of leeches, can often be obtained by no other 
means. To particularize some of these examples — In Cynanche 
Trachealis, or Croup, the application of leeches will very properly 
precede the employment of blisters ; and in Quinsy, when degluti- 
tion has been quite obstructed, and repeated venisection has proved 
unavailing, they have been known to afford very great relief. 

In inflammation of the pulmonary organs, local bloodletting is 
often employed with very great advantage, and leeches applied to 
the thorax may be considered as acting locally on the lungs. The 
close sympathy uniting the thoracic viscera, with the skin, explains 
satisfactorily the effects of these local bleedings on the Parenchyma 
of the lungs. They exercise beneficial effects, not only by the deple- 
tion which follows, but also by revulsion, deriving the fluids from 
these parts, by the excitement given to the Intercostal and Super- 
ficial arteries. 

In inflammation of the Trachea, and in that very common affec- 
tion, Bronchitis, in conjunction with other means, they are often very 
advantageous. In the painful, irritating cough, which accompanies 
the latter affection, the frequent pulse, difficult expectoration, leeches 
applied above the superior part of the Sternum, in the pit formed by 
the intermediate space, between the Stemo-cleido Mastoidei muscles, 
they will be found highly serviceable. In this place they act almost 
immediately on the inferior p/art of the trachea. 

When the Parenchyma of the lungs is affected, and when the 
Stethescope indicates some degree of hepatization, they are often 
beneficial. 

In inflammations of the abdominal viscera, leeches are much and 
very properly employed. When applied to the Epigastrium, in in- 
flammations of the stomach, they operate in the most powerful and 
direct manner on that viscus, and in inflammation of the intestines in 
the vicinity of the part affected. The flow of blood from the punc- 
tures may always be increased by washing them with warm water, 



Ii. 

and if necessary by applying cupping glasses. The effects of their 
employment, might be still further increased by covering the part 
with fomentations, emollient poultices, etc., removing them as they 
become cold. 

In diseases of the eyes, joints, and testis, as well as in inflamed 
haemorrhoidal tumors, the relief which they speedily afford, is ac- 
knowledged by most practitioners. 

In numerous instances of extravasation of blood under the skin, 
ecchymoses, contusions, etc., they are frequently applied with great 
benefit. 

In all cases of local plethora, or congestion, short of inflammation, 
so commonly attendant upon organic affections, especially of the 
heart, or large vessels, they are also useful. These local conges- 
tions are most conspicuous about the head, threatening or producing 
apoplexy, and leeching becomes an important preventive check. 

In infants of tender years, and persons who have a particular dread 
of bleeding, in cases where the practitioner is fearful of venturing on 
general bloodletting, leeches may often be tried with greater safety. 

In phlegmonous inflammations of superficial parts, their utility is so 
obvious, that I need say nothing upon this subject ; but in erysipela- 
tous inflammations, their value, though less known, is equally con- 
siderable. The practice is common in the French hospitals. In 
using them, it is most proper not to apply them immediately upon 
the inflamed surface, as the bites of these animals have, on many 
occasions, put on this species of inflammation; but they are di- 
rected to be placed upon a sound part, two or three inches from the 
diseased. 

When the erysipelas spreads extensively, and penetrates deeply, 
the inconvenience alluded to should be considered slight compared to 
the gangrene, or ploughing which threaten the part, and the leeches 
in consequence must be applied directly over the inflamed membrane. 
When thus used they should be scattered over the surface. 

Latterly the use of leeches has been extended from the external, to 
the internal surfaces, and their employment in this manner has been 
attended with effects highly gratifying. To illustrate their applica- 
tion in the latter cases — It has been observed that in Ophthalmia, 
more benefit has been derived from a single leech, or a couple, ap- 
plied to the inflamed conjunctiva, where it covers the lower eyelid, 
than by a dozen to the temples. So powerful is its operation, that a 
chronic inflammation of the eye which had continued five or six 
weeks, was immediately relieved, and by a second application of 
them, was in two or three days completely removed. The practice 
is perfectly safe, and according to the reports of Mr. Crampton, the 
most powerful we possess of speedily reducing inflammation. Useful 
as it is, it is not to supersede the other active measures which are 
necessary in lessening increased action. 

The manner of applying them to the conjunctiva. — The patient 
should be placed with his back to the light, in order that the lower 
eyelid may be everted without exciting pain. A leech or two,, rather 



lii. 

below than above the middle size, should be allowed to fix upon that 
part of the inflamed membrane, which covers the Tarsus, taking 
care that it fastens neither upon the ciliary margin, nor upon the eye 
itself. The leech fixes and fills itself in this situation, much more 
quickly than upon a cuticular surface, and this observation is equally 
true with respect to all internal surfaces, for which it is observed they 
have the strongest appetency. 

Leeches have also been applied to inflamed Tonsils. A single 
thread of silk is passed through the body of the leech, at about its 
lower third — thfc ligature being made fast to the finger of the opera- 
tor, it is introduced into the mouth, and its head directed by a probe, 
is brought into contact with the inflamed tonsil. The animal fixes 
itself to the part in an instant, and in less than five minutes being 
gorged with blood, falls upon the tongue and is withdrawn. Relief 
soon follows, and the part continuing to bleed for three or four hours, 
the inflammation is greatly reduced. 

Leeches are also applied to the internal surface of the nostrils, in 
affections of the head, connected with undue determination of blood 
to the brain, or with the suppression of an habitual epistaxis. 

These remarks comprise the practical applications of this article. 
Something may be said of the manner of using them. 

The part to which they are to be applied, should be first washed 
with soap and water, so as to remove the matter of perspiration, and 
the skin should be wiped dry. The leeches are to be placed on with 
the fingers, either one by one, or all of them together, by being placed 
in a tumbler, covered all over except one edge with a piece of linen, 
and applied close on the spot to be bled. As they will not stick to 
the glass, or the linen, they are in some measure forced to attach 
themselves as the surgeon wishes. The leeches should generally be 
suffered to fall off" the spot spontaneously. If forcibly separated, the 
teeth which penetrate the skin, and which swell when inserted, are 
apt to be torn off", and when this happens the wound is very likely to 
inflame, and the animal is rendered useless. 

When the patient's weakness, or any other circumstance requires 
them to be more speedily removed, they may easily be made to drop 
off", by sprinkling them with a little salt or snuff". Such as fall off 
spontaneously, may be used a second time, for they remain possessed 
of their teeth, and to prevent them suffering from their engorgement, 
they should be put into a weak solution of salt and water, which 
causes them to discharge the blood. Such as are carefully attended 
to, may be used five or six times. 

The number to be applied, will vary with the exigency of the case, 
and the age of the subject. FW an infant of very tender age, from 
three to six — as years advance the number may be increased to thirty, 
forty, or sixty. 

The quantity of blood drawn by each leech, will depend upon the 
quality. A single French leech, it is said, will draw half an ounce 
of blood. Ours do not take so much, but the bleeding from the 
punctures is often very considerable. The majority of American 



llii. 

leeches take from two to three drachms each, which is the quantity 
calculated upon in a prescription for their employment. 

References. — Johnson on the Leech; Poliniere Sur les Emissions 
Sanguines. 

CUPPING 

Is another method practised, for abstracting blood from a part, and 
is resorted to when to the loss of blood it is also desirable to excite 
much irritation on the skin. For this purpose it is better adapted 
than leeches, and therefore it can only be employed where the skin 
is sound, or be applied to parts distant from the diseased. It is to this 
power of deriving the fluids to the surface, which cupping possesses in 
a high degree, that we must ascribe its superiority in many cases 
over leeching, while it is obvious, that in other instances this last 
has advantages which are almost peculiar. In local inflammatory 
affections, inasmuch as blood drawn immediately from the part, will 
afford most relief, leeches are decidedly preferable. In deep seated 
affections, over which the skin is sound, it has been considered a 
matter of indifference by what means blood was drawn from the part, 
though from what I have said, a preference should be given to cup- 
ping. At present, leeching is the method of abstracting blood to 
which physicians are most partial, and as it is less painful, and more 
blood can be drawn by them with convenience, they may maintain 
their rank ; but cupping is a good substitute, and a very valuable 
agent. 

The diseases to which this remedy is adapted, will correspond with 
those which have been already mentioned under the head of leeching. 
They may, however, be enumerated, and are as follows : — headache, 
delirium, phrenitis, the various grades of madness, vertigo, in all ten- 
dencies to apoplexy, — in inflammation of the eyes, and inflammatory 
affections of the chest, — in asthma, dyspnoea from various causes, etc. 
Cups are applied to the temples, to the scalp, the back of the neck, 
along the spine, to the chest, and in various other situations. The 
operation is very simple, but to acquire dexterity much practice is 
required. 

It is performed in the following manner : — the skin being softened 
by means of a sponge and warm water, a small bell-shaped glass 
vessel, or other material, having the air previously exhausted, by 
being held over the flame of a lamp, or by burning in it tow, or pa- 
per, is immediately applied to the part. The edge of the cup must 
be accurately adapted to the skin, and no substance, as hair, should 
be interposed, otherwise the external air will fill up the vacuum and 
the cup will not adhere. The adhesion of the cup to the skin, or in 
common language the suction, which takes place, depends upon the 
pressure of the air upon the surface of the exhausted cup, and from 
the absence of the same pressure upon the skin — it swells, and rises 
in the cup, the vessels are enlarged, and become very red and turgid. 
When this state has continued a few minutes, the cup is removed 



liv. 

and the scarificator is applied, — the depth of the lancets being regu- 
lated by the vascularity of the part, and the quantity of blood desired. 
When a sufficient quantity of blood has collected in the cup, it is 
removed by gently introducing the nail of the fore finger under the 
edge, by which means the air is allowed to rush in, and the equili- 
brium being restored, the vessel falls off. The skin and the edges of 
the wounds being washed of the blood, and the coagula which have 
formed, the cup is again attached by the same means, and then re- 
moved, until a sufficient quantity has been drawn. When the opera- 
tion is completed, the wounds made by the scarificator are anointed 
with a little sweet oil or simple cerate. 

When a cupping glass is applied alone without scarifying the part, 
the operation is called dry cupping, and is employed to produce speedy 
irritation on the skin for the relief of oppression, shortness of breath- 
ing, or pains about the thorax and abdomen, etc. Cups may be made 
of tin or copper. Small tumblers may also be employed for the same 
purpose. 

Lately Dr. Barry has recommended the application of cupping 
glasses to poisoned wounds, with a view of preventing the absorption 
of the venomous matter. The experiments which were performed to 
illustrate their utility, were as follows : — Wounds were made upon 
the back and thighs of full grown rabbits, and when the blood had 
ceased to flow, two or three grs. of Strychnia, in powder, or ii. or iii. 
drops of Hydrocyanic Acid were introduced into the wounds: then, 
after intervals of three, five, and ten minutes, a cupping glass was 
applied to the wound, which was renewed as often as it fell off. No 
symptoms of poisoning occurred in these animals; but if on the con- 
trary,' this precaution was not taken, they all died. On one occasion 
Dr. Barry waited until the animal became affected with convulsions, 
nevertheless he succeeded in saving it by these experiments. 

M. Lannec has repeated these experiments, and has verified their 
results. Six drops of Hydrocyanic Acid were poured into a little 
wound made in the thigh of a rabbit — the cupping glass was applied 
for twelve minutes, and the animal showed no signs of having been 
poisoned; but when it was taken away, convulsions came on so sud- 
denly, that it was thought to be dead — but a fresh application of the 
glasses restored it to its former state of tranquillity. The same effects 
ensued upon removing it again, and it was only half an hour after the 
introduction of the poison that it could be removed with impunity. 
Another rabbit, treated with the same quantity of acid, died in two 
minutes. 

Other deadly poisons, as Arsenic, the Upas Tieute, etc., have been 
employed in the same manner, and when the glasses were applied no 
poisonous symptoms appeared, but were soon produced if they were 
not. 

Dr. Barry in studying the phenomena of the venous circulation, 
was astonished that the pressure of the atmosphere, was either left 
out, in the enumeration of its causes, or considered merely as a secon- 
dary agent. Attnospheric pressure he believes necessary. Absorption 



lv. 

he does not look upon as a vital function, but as a physical effect, 
dependent on the same cause, as the venous circulation, i. e. atmos- 
pheric pressure. Hence he concluded, that as the circulation and 
absorption are dependent upon atmospheric pressure, if this could be 
removed as by forming a vacuum, absorption would be prevented. 
Hence the various experiments instituted with this view, and in per- 
forming- them the most deadly poisons were employed. The results 
were in many instances surprising, the action of the articles upon the 
system being suspended or excited, by the application or removal of 
the cupping glasses. 

The experiments of Dr. Barry have been repeated by Drs. B. Pen- 
nock and Rodrigue, and his statements fully confirmed. They differ 
from him, however, in the explanation given of their mode of opera- 
tion, and attribute to pressure only the good effects derived from their 
application. They tried pressure simply, without exhausting the air 
of the glasses, and found the same results to take place. They attri- 
bute, therefore, the good effects which follow the use of the glasses 
to pressure, which acts by interrupting the action of the absorbents, 
and paralysing the nerves. 

Note. — The treatment I would pursue in bites of venomous reptiles, is, the 
application of a ligature above the affected part, and the employment of suction 
by the mouth. This method I would recommend, in cases of poisoning, or sus- 
pected poisoning from animals, as more prompt, more effectual, and, I think, 
perfectly safe. Inasmuch as it can speedily be practised, it is superior to excision 
or caustic. If there are no ulcers in the mouth no apprehension need be enter- 
tained, for should a portion of the saliva impregnated with the poisonous matter 
be swallowed, no injury would result, since from the experiments of Orfila, the 
poison of the Viper may be introduced into the stomach with perfect safety. 



MATERIA MEDICA. 

Divided into aliments and medicines — Definition — Brief account 
of the various plans of arrangement which have been pursued — First 
in point of time and simplicity is the alphabetical arangement of 
medicines — remarks upon it. 

Another mode was founded on the class of bodies or kingdoms, to 
which the different substances belonged. 

Another upon an investigation of the sensible and most obvious 
qualities of the medicinal substances. 

Another upon the medicinal operation of the article upon the 
system. 

A fifth, into classes, according to the systems of the body upon 
which their action is exerted. 

The arrangement preferred, will be as follows — with remarks in 
explanation. 



IV11. 

Materia Medica. 

The Materia Medica is commonly considered as divided into Ali- 
ments and Medicines. 

This division, though not always followed by systematic writers, 
is certainly correct, and may be made productive of much practical 
utility. The subject of Aliments has been overlooked by Dr. Chap- 
man, and some reflections made, calculated to place this division not 
in the most favorable or important point of view. In this respect I 
differ very essentially from such respectable authority, having al- 
ways considered a well directed diet, one of the most important 
adjuvants to medicine, and in some cases, indispensable for a full res- 
toration to health. For though you need not be informed of the solid 
qualities of beef and mutton, of the delicacy of poultry, or the flavour 
of game, and so on, yet you should all be acquainted with the 
kind of diet, which will suit different disorders, and more particularly, 
how to direct the regimen of your patients in such a manner, as to 
shew yourselves not unmindful of their comfort, and of the very 
essential aid, which is to be furnished to your medi9al treatment from 
this source. For these reasons I shall devote several lectures to the 
subject of Aliments, and though it is usual to commence with their 
consideration, I shall defer it to the conclusion of the course. 

Of the Materia Medica Propria. 

By this term is meant, as I have observed, that department of 
Medical science, which teaches the knowledge of remedies, or the 
substances employed in the cure of diseases. The subject diffuses 
itself very extensively. Under it is considered, the Natural and the 
Chemical History of the different articles, and the method of prepar- 
ing them for use — the application of these articles to diseases, their 
doses, and the best modes of administering them. 

Previous to the consideration of these points, it will be proper to 
treat of the Classification of so extensive, and multifarious a list of 
remedies as this branch comprises. The importance of a good ar- 
rangement, in facilitating the acquirement of knowledge, is too well 
known to require any comments in this place — a good system of 
science being like a fine building in architecture, where from the skill 
of the architect, the various rough and heterogeneous Substances, which 
enter into its composition, are so ordered, each in its proper place, as to 
present to the eye, a uniform and harmonious whole — so in the Materia 
Medica, the confusion which would arise, from so large a number of 
articles being irregularly treated, yields at once to the simplicity, order, 
and ready comprehension afforded by a judicious Classification. 

The great improvers in Medicine, as in other branches of Science, 
seem to have been desirous of associating together, things, which in 
their nature, appear to have an obvious connexion. No branch of 
Science, affords a more manifest foundation for associations, than that 
which treats of the different articles employed for the cure of diseases. 
To this probably it is owing, that the distribution of Medicines into 
8 



lviii. 

classes, is at least -as ancient as the first medical writings now ex- 
tant, perhaps as the art of Medicine itself. ' From the prevailing 
passion for novelty, as well as from attempts at improvement, it 
might readily be imagined, that during a period so extensive as that 
in which Medicine has been practised, many different distributions 
would be formed, and of course a variety of general terms introduced 
for expressing them. That you may form some idea of the various 
distributions which have been made, and of the difficulties to be en- 
countered on this subject, I shall bring before you, a few of the va- 
rious methods which have been proposed. 

The first in point of time, and simplicity, is the alphabetical ar- 
rangement. 

From this however it is obvious, that we can derive no information, 
with regard to the specific virtues of various substances admitted 
into our catalogue of the Materia Medica. 

Another mode of arrangement is founded on the class of bodies, or 
kingdoms, to which the different substances belong ; and thus we 
obtain three general divisions, of Animal, Vegetable, and Mineral 
Substances. This method of classification, is liable to the same ob- 
jection as the former, as it is too general, indiscriminating, and unin- 
structive. 

Another method proposed, is that, to which we are led by an in- 
vestigation of the sensible, and most obvious qualities of medicinal 
substances, and they are considered, as they are acid, or alkaline, 
acrid, astringent, aromatic, glutinous, unctuous, bitter, emetic, or ca- 
thartic. This mode is also too vague, and inappropriate, to admit of 
general application. For some substances have no discriminating, 
sensible qualities, others possess several so nearly similar, that it is 
difficult to refer them to one class, in preference to another : and others 
again, resemble one another in their sensible qualities, and yet are 
very different in their effects on the human frame. 

Other arrangements have been made, founded upon the medicinal 
operation of the articles upon the system. This method must be 
considered the best for Classification, as well as to present to our view 
the predominant characters of such a variety of articles, as the Ma- 
teria Medica comprises. It is evident, that medicines ought to fur- 
nish the characters, which serve to unite, or to separate them ; and 
what characters can be preferable to the effects, physiological, and 
practical, which they excite. . It is the impression that a medicine 
makes upon the organised tissues, — it is the results which follow their 
application upon these parts, which must determine its place, in a 
methodical distribution of medicinal agents. In executiug an ar- 
rangement founded upon this principle, however, various methods 
have been pursued. While the outline has been admitted, the filling 
up has presented pictures as various as the persons who have been 
engaged. Dr. Cullen, in pursuing this plan, has arranged the articles 
as their operation is exerted upon the solids and fluids of the body, and 
has distributed the various substances into twenty -three classes. Dr. 



lix. 

Darwin comprehends them all under seven classes. While Cullen'e 
classification has been thought too diffuse, Dr. Darwin's is much too 
contracted, and adapted only to his own exceptionable system of Pa- 
thology. 

The arrangement into Classes, has within a few years been the 
order pursued by most writers on the Materia Medica. They have 
differed from each other, in the number of these classes, and a few 
distinctions of but little value. Of late it has been usual to arrange 
the articles of the Materia Medica, according to the Systems of the 
body, and to treat of them, as their action is exerted upon any of 
these systems. 

The following arrangement will be pursued in these Lectures — 

1. To speak of those medicines which irritate the Stomach and 
Duodenum — This division comprising Emetics. 

2. Those which irritate the internal surface of the Intestines — 
This division comprising, Cathartics. 

3. Those which increase the natural operations of the Intestines, 
without exciting irritation — Laxatives. 

4. Those which destroy or counteract morbid Substances, lodged 
in the Alimentary Canal — Anthelmintics — Antacids. 

5. Medicines which promote particular Secretions — 

a. Of the Skin — Diaphoretics. 

b. Of the Kidneys — Diuretics. 

c. Of the Uterus — Emmenagogues. 

d. Of the Salivary Glands — Sialagogues. 

e. Of the Bronchial Passages — Expectorants. 

6. Medicines which strengthen the organised Structures — Tonics. 

7. Medicines which in strengthening also restrain excessive dis- 
charges — Astringents. 

8. Medicines which lessen the energy pf the nervous and muscular 
systems — Narcotics — Antispasmodics. 

9. Medicines Incerta Sedis, i. e. those whose action is not well de- 
termined, and which cannot with propriety, be arranged under any of 
the foregoing divisions. 

In this proposed distribution, there are as many classes of medicines 
as are sufficiently determined by their characters, and by the phenom- 
ena which are proper to them. Each division represents a particular 
medical property, which is discoverable in all the natural substances 
comprehended under it. It is not to be understood, that this property 
is the same in all the different substances: — experience proves that 
each has not the same degree of energy, but it is sufficient to jnstify the 
alliance which is made, that each exerts the same organic operations, 
and that the substances of each class, produce an action bearing con- 
siderable resemblance to each other. 

But though the plan proposed is as good as any, yet it is not with- 
out objections — the principal is, that some substances being possessed 
of various powers, their proper places are not easily ascertained, and 
they must necessarily be considered under different classes — instances 



Ix. 

of which may be given in Calomel, Tartarized Antimony, and others. 
The former acts as cathartic, sialagogue, alterative, and hence a repe- 
tition becomes unavoidable, and to render its history complete, it must 
be considered under each of these classes. Tartarized Antimony 
being emetic, cathartic, diaphoretic, and expectorant, according to 
the doses in which it is given, it becomes necessary to recur to it, 
when considering the separate medicines which are arranged under 
these several heads. But as there is no mode of classification, with- 
out some objections, I shall pursue this method, as being least objec- 
tionable, observing that I shall treat of every article more particular- 
ly, under that head in which its powers are most conspicuous, and 
that when from a difference in its preparation, or its exhibition, other 
properties are discovered, it must again be considered, under such other 
divisions, as correspond with the virtue specified. 

It should be observed, that though I have made a classification of 
medicines, into Emetics, Cathartics, Diaphoretics, Emmenagogues, 
Tonics, &c, it is not meant to be understood, that the medicines of 
these classes, act in any of these modes uniformly and invariably. The 
contrary is too often the case. From causes to be referred to the 
states and conditions of the organs attacked, the same remedies ex- 
hibit often the most opposite effects — thus a Cathartic will often 
prove Emetic, and the reverse. — A Febrifuge increase Fever, a Tonic 
will add to the existing debility — Antispasmodics aggravate the af- 
fections they were designed to remove. 

It must be evident, therefore, that in this arrangement, nothing can 
be considered absolute ; but that the operations of Medicines, will be 
modified by the condition of the organs or system, to which they are 
applied. In prescribing an article with a view to a determinate end, 
it is important, that the condition of the part or system be as accu- 
rately known, as our present state of Pathology will admit — that the 
nature of the impression made by each medicine, as well as the force 
of that impression, be also known, with the modifications to be pur- 
sued, as relates to age, sex, idiosyncrasy, climate, season — that the 
preparation be such, as to furnish all the results that may reasonably 
be expected, after all the foregoing knowledge has been obtained ; 
and lastly in what shape, or what states of combination, the medici- 
nal agent produces the most powerful and beneficial effects. Upon 
some or all of these subjects, it will be my duty to enlarge; and as 
much as in my power, to afford you just, reasonable and proper views 
upon the action of Medicines, so that without extolling them unduly 
on the one hand, or depressing them unnecessarily on the other, present 
you such changes, either in the body to be acted upon, or the agent 
as will secure, or defeat, the intentions we may have in view. 

Pursuing the arrangement proposed, I shall consider under the first 
division 



Ixi. 

Division I. 
Medicines which irritate the Stomach and Duodenum. 

This comprises those articles termed Emetics. 
In commencing any of the divisions, the following is an abstract 
of the leading objects which will be considered : 

1. A definition of the class. 

2. The direct effects of the class, and the changes induced in the 
system by these direct effects. 

3. The effects of the elass, in the cure of Diseases, and practical re- 
marks upon its use in particular diseases. 

4. Directions to be observed in the use of the class. 
The history of the particular articles. 

1. The Natural History. 

Under this head will be considered its Natural Family — sensible 
qualities — chemical analysis. 

2. The Medical History. 
The preparation of the article. 

1. For a convenient form. 

2. For preservation. 

3. For external use. 
Combinations of the article. 

1. For augmenting its virtues. 

2. For correcting its active powers. 
Lastly — The Adulterations. 

EMETICS. 

By Emetic Medicines are understood substances which excite vo- 
miting independent of any effect arising from the mere quantity of 
matter introduced into the Stomach, or of any nauseous taste, or smell, 
or of any acrid, or narcotic power — but by a specific impression upon 
the stomach itself. The importance of this class of Medicines must 
be known to all of you, exercising, as it does, an immediate control 
over the operations of so essential an organ as the Stomach. For as 
vigour of body, and a free exertion of the intellectual powers, depend 
upon the healthy state of its function^, so in disease its disordered 
secretions, or the morbid matters it contains, tend greatly to depress and 
enfeeble them. The beneficial tendency of this provision which 
evacuates the morbid contents of an organ, or changes its secretions, 
must be apparent. Emetics were therefore so much celebrated among 
the ancients, that Hippocrates even recommended them to the healthy, 
if they wished to remain so, and advised their frequent repetition. 

Upon the employment of Emetic Medicines, several prejudices 
have commonly existed, which it would be proper to correct before I 
proceed further. It has been supposed by some, that vomiting was 
an unnatural operation, and one therefore which ought to be consid- 
ered hurtful. Vomiting is an operation of the stomach, to which na- 
ture often has recourse to expel offensive matters — it may therefore 
be considered salutary, and one which may with propriety be imita- 
ted by art, with this great advantage, that bile or irritating substances 



lxii. 

lodged in the stomach, or duodenum, can with greater facility be evac- 
uated in this manner, than through a convoluted tube of more than 
30 feet in length. Accordingly it will be found, that the operation of 
a single Emetic, will evacuate more offensive matter from the stomach, 
with more certainty, as well as more immediate relief, than a course 
of mild medicines will do, of several days duration. Another objec- 
tion to Emetics, is, that they are weakening remedies, and will ex- 
haust the patient too much. This objection will also appear equally 
unfounded : for the weakness which occurs in the early stages of dis- 
ease, does not arise from real exhausted strength, but from the ner- 
vous system being depressed, in consequence of the action of morbid 
substances upon the stomach, and which is extended over the system. 
Any degree of languor, or weakness, produced by an Emetic, cannot 
be so mischievous, as suffering the morbid cause to continue in action. 
Whatever therefore will evacuate it from the system, so far from 
weakening, will restore strength, and this fact all of us must have 
experienced, either as relates to Emetics or Cathartics. 

The Immediate Effects of Emetics, and the Physiological 'phe- 
nomena following their employment.* 

An Emetic substance scarcely arrives in the Stomach, than it man- 
ifests its character. It irritates this organ ; it excites -an increase of 
vitality in the mucous membrane, the blood penetrates it, the capillary 
net-work existing upon its surface is more apparent, and the surface 
becomes more red and more sensible. These effects are extended to 
the duodenum, and the same organic phenomena excited. This in- 
crease of the vital energies of the Stomach is only of short duration. 
If the irritation caused by an Emetic, was of long continuance, it 
would cease to belong to those operations which are considered san- 
atory, it would partake of the action of disease. But the impres- 
sion is soon effaced, without leaving any traces of its effects, within 
a very short time after they are administered. To these effects of an 
Emetic, others quickly succeed. It is important to particularize 
them. 

1. The Serous exhalation, which in a natural state, moistens the 
interior of the Stomach, is soon increased to a considerable degree. 
The great increase of this secretion cannot be doubted, when we re- 
collect the quantity of this fluid, which is often discharged by persons 
under the operation of an Emetic. Darwin relates the case of a 
man who had only drank a pint of fluid, and yet discharged by vo- 
miting, six pints of this Serous substance. 

2. The secretory action of the mucous follicles of the Stomach is 
also increased a considerable degree. The thick, ropy, viscid matter 
which is rejected by vomiting, is the consequence of their great ac- 
tivity. 

3. Emetics increase the secretory function of the liver, and the 

* Vide Barbier, Traite Elementaire. 



Ixiii. 

abundant discharge of bile is the consequence of their operation. It 
is impossible to believe, that the quantity of bile frequently ejected, 
could have existed in the Stomach, or duodenum, previous to the taking 
of the Emetic. The secretion of this fluid, is often excited by the 
medicine taken, and is the result of the exercise of its influence upon 
the animal economy. The irritation which the Emetic substance 
makes upon the surface of the duodenum, is extended by the Ductus 
Communis Choledochus to the liver, it excites its vital operations, 
causes a flow of blood, to this organ, and in consequence an in- 
creased secretion. Particles of the Emetic substance, may also be 
absorbed by the branches of the vena portse and carried to the liver, 
and add another irritant to this organ. It is probable too that the 
compression the abdominal viscera undergoes in vomiting, might by 
acting upon the gall bladder, promote a discharge of its contents, and 
thus increase the quantity evacuated. The fluid being poured in the 
duodenum, is by the action of this organ transferred to the Stomach, 
and from thence discharged by its contractile efforts. 

It is easy to conceive, why bilious matter is not thrown up, when 
vomiting takes place, immediately after an Emetic is swallowed. 
The irritating operation of the article, has not been extended to the 
duodenum, neither has the liver been affected by the same action. 
But when the operation has not been prompt, biliary matter is always 
mixed with the contents of the Stomach. 

The Pancreas partakes also of the irritating operation of Emetic 
articles, its secretory action is equally accelerated after their use. 
The action of the Emetic does not cease with these effects. The 
muscular coat of the Stomach and duodenum feels the influence of 
this new irritation. By its contraction the contents of this organ are 
expelled, and we have all seen how wolent and severe it is in many 
cases, being so complete as to reject the smallest quantity of fluid 
which had been swallowed. Connected with this subject is the 
change which has taken place in the regular and accustomed opera- 
tions of this coat. Instead of proceeding in its regular waving mo- 
tion from the Cardia to the Pylorus, its action is completely inverted, 
and the contractions proceed from the Pylorus to the Cardia. Various 
attempts have been made to explain the inverted operation of this 
organ, but no satisfactory reason has been assigned, and will probably 
ever remain among the inexplicable operations of the system, which 
while operating for our benefit, their essential nature we are unable 
to explore. It is not always produced by the operation of irritating 
agents upon the Stomach, since it often occurs when the system is 
depressed and debilitated from local and general causes, as after syn- 
cope, or in injuries of the brain. 

After the remarks I have make, little doubt would be entertained 
by you, that the evacuation of the Stomach was the result of an 
active operation of this organ. Magendie, the most distinguished 
physiologist of the present day, maintains that the Stomach is passive, 
and that vomiting is occasioned by the pressure of the abdominal 



lxiv. 

muscles and diaphragm upon it. An opinion, so much at variance 
with the received impressions, excited the attention of physiologists 
to an investigation of the particular actions, excited by an Emetic. 
The experiments of Magendie have been repeated by Mr. Harrison in 
his Gulstonian Lecture before the College of Physicians, and while 
the importance of the action of the diaphragm and abdominal mus- 
cles has been acknowledged, the contractions of the Stomach were 
also considered necessary to effect the expulsion of its contents. The 
impression which seems to prevail among the leading physiologists of 
the day, founded on a variety of experiments is, that in vomiting con- 
tractions of the Stomach do take place, but that for these contractions 
to be effectual, the resistance of the diaphragm and abdominal mus- 
cles is required or something in its stead. The experiment has been 
made of giving an animal an Emetic, and dividing the abdominal 
muscles, It was then observed that while contractions took place, 
yet all the efforts of the organ were useless to eject its contents, 
until the hands were applied in the place of those muscles, when the 
Stomach being forced against the resistance made, vomiting was in- 
stantly accomplished. It is therefore decided, that the Stomach un- 
dergoes contractions, but that to effect its evacuation, the aid of the 
diaphragm and abdominal muscles is required. Such would be our 
conclusion from the uniformity which take place in this operation — 
the diaphragm becoming contracted and fixed, the ribs drawn down, 
the abdominal muscles drawn inwards, so that the Stomach is pressed 
on all sides by voluntary muscles, its own contraction is all that is re- 
quired, and is what does take place to expel its contents. 

The action of vomiting considered in a Physiological relation is 
not what ought chiefly to interest us. It is the actions which it ex- 
cites in various parts of the body — it is the changes which are pro- 
duced in the exercise of its functions, which are important to be 
known. We need only recur to an individual under the operation 
of an Emetic, to be convinced that the influence which it exercises 
upon all the organs, is of a very powerful character. This leads me 
to consider 

The general effects of Emetics. 

1. Upon the brain and nervous system. 

The impression made upon the nerves of the Stomach, is soon ex- 
tended to other parts of the system, to the brain, spinal marrow, sym- 
pathetic nerves and ganglions. To the excitement thus produced are 
we to attribute the movements which take place in the other systems 
of the body, and the impression which is often made upon the morbid 
actions which exist. 

2. Upon the circulation. 

The pulse under their influence is considerably and variously affect- 
ed. Under the feelings of nausea it is more frequent and smaller 
with vomiting it is much augmented in volume, determinations take 
place to the brain to a considerable extent, as evinced by the redness 
of the face, swelling of the jugulars. The minute system of vessels, 



Ixv. 

or the capillaries, have likewise their action increased and blood is sent 
to them to a large extent. To this state succeeds diminished action, 
languor in the intellectual and bodily functions, with a disposition to 
sleep. 

The secretions are excited. 

Expectoration is promoted — the contraction of the diaphragm and 
abdominal muscles with their alternate relaxation, variously agitates 
the motion of the air in the lungs and bronchia, and thereby promotes 
expectoration. 

Emetics also act as Diaphoretics — there is a consent between the 
vessels of the Stomach and the surface of the body, so that the several 
states of them are mutually communicated to each other. The ac- 
tion of an Emetic exciting nausea, with a copious effusion of the 
fluids of the Stomach, a relaxation of the vessels of the skin takes 
place, with an increase secretion from the surface. 

Emetics increase the power of the Absorbents, as it is known that 
buboes in a state of suppuration, and other swellings, have been dis- 
persed by their operation. This effect may be explained by the 
nausea excited reducing arterial action, and by a peculiarity of the 
absorbent system, Dr. Chapman observes, its functions are most active 
when the arterial is most depressed. 

Emetics also act upon the Kidneys — but this may be considered an 
indirect result of their operation. For if the absorbents are excited to 
activity, there appears no difficulty in accounting for the action of -the 
kidneys, for if water be absorbed, it must be discharged, and that 
through the kidneys. 

Rules to be observed in the administration of Emetics. 

In all diseases where much Plethora is present, or when the habit 
tends to it, and where the condition of the patient requires at the 
same time an Emetic, blood-letting ought always to precede it, lest 
the strong effort of vomiting should rupture the distended vessels of 
the head, and thus bring on apoplexy, or a discharge of blood, from 
other parts of the body be produced. In addition, vomiting seems of 
most use, which is excited immediately after bleeding, for the incon- 
veniences of a plethora are then avoided, and the salutary effects of 
the Emetic are more certainly obtained, especially if the disease is a 
Fever, which requires the aidof both. 

2. When the necessity is urgent, and a quick operation is desired, 
a large dose of the most active Emetic must be given. 

3. In ordinary cases, it is best to give them in divided doses. 
Thus 4 or 5 grains of Tartarized Antimony may be dissolved in 4 or 
5 table spoonsful of water, of which 1 table spoonful may be taken 
every 10. or 15 minutes until vomiting is excited. Then encourage 
it with tepid drinks, chamomile tea, &c. 

4. If the operation of an Emetic is too violent, the best means of 
checking it is Laudanum in large doses, fomentations to the stomach, 
and sinapisms to the feet. If these fail, an anodyne enema and a 

9 



lxvi. 

blister to the stomach, or what would be preferable, a cataplasm con- 
tinued as long as it could be borne. Sinapisms to the feet are very 
powerful in allaying the inordinate contractions of the Stomach. 

In irritable conditions of the Stomach, whether brought on by 
Emetics or other causes, there is one direction which I wish particu- 
larly to impress upon you, viz. the absolute necessity of administer- 
ing medicines and drinks in the smallest possible quantity. In this 
condition, the common people administer a variety of substances and 
to an unlimited extent. The thirst being urgent, drinks are freely 
taken, but from the irritable state of the Stomach, they are thrown 
up as freely. The best direction is to give as little as possible — a 
mouthful or table-spoonful will be sufficient to moisten the mouth 
and throat, more will be rejected — sometimes entire abstinence is best. 

5. Do not allow the apparently inactive state of the Stomach to 
induce you to augment the dose of an Emetic to a preposterous ex- 
tent. Remember, as Dr. Paris observes, that although the Stomach 
may be unable to void its contents by vomiting, it may, nevertheless, 
retain its sensibility, and be therefore liable to inflammation. A case 
is related of a Practitioner attempting to excite Emesis in an epileptic 
patient, by a large dose of Sulphate of Zinc, which produced inflam- 
mation of the Stomach, and a fatal termination. When the Stomach 
resists the action of one article carried to a reasonable extent, the best 
practice would be, to have recourse to another. 

The great importance of this class of remedies, will excuse my 
entering a little into detail, in its application to diseases. 

Application of Emetics to Diseases. 

They are adapted to a great diversity of cases. When we con- 
sider the extensive surface which the Stomach and Intestinal Canal 
presents to the variety of irritating matters which are daily introduced 
into them, from the combined sources of extraneous articles of food, 
and the occasional morbidity of their natural secretions, it is no way 
surprising, that the primae viae are observed to be that part of the 
system, where we meet most frequently with those irritations, which 
produce, and keep up diseases. In addition to these sources of irrita- 
tion, it happens from the affinity which subsists between the surface 
of the body and the Intestinal Canal, that when the general perspi- 
ration is checked, by some external occasional cause, as by the appli- 
cation of cold, the natural secretions into the cavity of that Canal 
are increased, which secretions when allowed to remain there so as 
become acrid, re-act again upon the system, and thus add to the gen- 
eral exciting causes. 

It is in the various grades of Febrile action, that Emetics will often 
be found to exhibit their best effects. These diseases are always 
connected with symptoms, which mark a departure from the healthy 
condition of the primae viae — as impaired appetite for food, weight at 
the precordia, and abdominal distension; with nausea, thirst, and 
furred tongue. Here then we see the propriety of having early re- 



lxvii. * 

course to Emetic medicines, which by speedily evacuating the Sto- 
mach of its morbid contents, tend strongly to dissolve the paroxysm 
of fever. Accordingly, they should be of on activenature, such as 
while they evacuate freely, should make such an impression, as to 
dissolve any morbid associations which may have been formed, and 
which keep up, and prolong disease. 

They are not necessary in every case of fever. When the disease 
has been preceded by a meal, which oppresses the Stomach, they 
should be administered immediately. They should also be adminis- 
tered when nausea oppresses the patient, and when this is supposed 
to depend upon bile, or other irritating fluid — when there is an unplea- 
sant taste in the mouth, and when the tongue is furred — when head- 
ache exists, and there is reason to believe that the general derange- 
ment of the system, proceeds from this source. Under these circum- 
stances they may be administered with the greatest advantage. They 
are absolutely contra-indicated in Febrile diseases, when there is 
determination to the Stomach, and intestines. This determination is 
indicated, when the Stomach is irritable, with occasional vomiting of 
thin fluids, or frequent retching — when the tongue is red — when pain 
and soreness exist in the epigastric region, upon pressure being made. 

In the Bilious Remitting, and Intermitting Fevers, of our country, 
they are often indicated, and may be had recourse to with the happi- 
est effects. 

In Intermittents, their operation is sometimes remarkable, not un- 
frequently putting a stop to the disease, without the employment of 
any other medicine. They have been recommended for the purpose, 
not only of cleansing the primae viae, but of preparing the Stomach 
for bark. Judging from my experience, I should speak favourably of 
the practice, as I have witnessed a more prompt operation of the 
bark after this preparatory process, than when it was not pursued. 

Emetics are useful as Diaphoretics. 

I have spoken of the utility of Emetics in Fevers as evacuants — 
but they are subservient to other valuable purposes. Among them 
may be mentioned the removal of the morbid stricture of the vessels 
of the skin, which may be considered as the principal accessory cause 
of uneasiness. Accompanying this morbid stricture, there is either 
an increased evolution, or a morbid retention of heat, which adds 
greatly to the irritation, and excitement of the nervous and arterial 
systems. Emetics therefore not only by their impression upon the 
Stomach, but by determining the circulation to the extreme vessels, 
contribute very much to produce diaphoresis, and thereby is opened a 
channel, by which the superabundant heat is carried off. 

In many of the deranged conditions of the Alimentary Canal, 
Emetics are extremely valuable. In Dysentery and Diarrhoea, they 
are very advantageously employed, for their Diaphoretic operation. 
With the skin, the Alimentary Canal possesses an intimate connec- 
tion, and in most of the affections of the latter, the functions of the 
former will be found in a deranged condition. The skin is unques- 



lxviii. 

tionably the principal excretory organ of the body, and from the ex- 
periments of Sanctorius, much the larger portion of the ingesta, are 
carried off by this channel. Accordingly, when its secretory func- 
tions are suppressed, morbid action is excited in other parts, and dis- 
ease ensues. Emetics then relieve the stomach and bowels, and by 
the excitement they produce, determine the fluids by a revulsive ope- 
ration into other parts of the system, and particularly dispose to a 
renewal of the excretory functions of the skin. The utility of this 
practice is confirmed by Dr. Moseley and Sir John Pringle. Dr. 
Cleghorn was in the habit of giving -the Pulv. Ipecac, in combination 
with Vitrum Antimonii Ceratum, in such doses as to empty the 
intestines as soon as possible. The cure may then be completed with 
small doses of any of the diaphoretics, as Ipecac, with Opium, Do- 
ver's Powders, dieting, &c. 

In Diarrhoea, the same remedies will also, often prove serviceable. 
In Dyspepsia, Emetics given occasionally, are productive of great 
benefit in the early stages of the disease. They should not, however, 
be repeated too often, as they would weaken and otherwise impair 
the tone of the Stomach. Their effect is to remove the acid con- 
tents of the primal vise, and to promote the intestinal secretions. 
Emetics emulge the biliary ducts, and promote the biliary secretion. 
In obstinate constipation — The general practice in this disease has 
been, to have recourse to Mercury, until salivation is induced, after 
the usual evacuating medicines have been carried to a sufficient ex- 
tent, without success. This is most commonly successful, and its 
good effects seem to depend upon its exciting the biliary secretion, 
by which the bowels are stimulated to a discharge of their contents. 
Emetics produce the same effects. They emulge the biliary ducts, 
and cause a more copious discharge of bile — while by their febrifuge 
and relaxing operation, they remove the Fever, the inflammation, and 
the constrctioin, which constitute the most dangerous as well as dis- 
tressing symptoms that attend a constipated state of the bowels. 
Dr. Hosack relates several cases of persons subject to attacks of ob- 
stinate constipation, who could only be relieved by Mercury, carried 
to the point of salivation, after V. S. Cathartics, blisters, the warm 
bath, and enemata of Tobacco had been employed without success. 
Yet these persons in attacks, equally violent as those which required 
the above treatment, have been promptly and effectually cured by 
Emetics, which excited free and copious vomiting. 
Emetics act as Expectorant and revulsive Remedies. 
In most of the diseases of the Thorax, Emetics are highly recom- 
mended — particularly in some of the acute affections. In Pneumonia 
Notha > after the inflammatory action has been subdued, or when the 
congestive state of the lungs exists, in a high degree from the begin- 
ning, Emetics in repeated, but small doses, are more useful than any 
other remedies we can employ. Their utility in equalizing the cir- 
culation, is particularly obvious in this disease. Here the blood, driven 
as it were, from the smaller vessels, and from the surface, is accumu- 



lxix. 

lated in the larger vessels and in the lungs. To such a degree is this 
organ oppressed, by the degree of congestion, that Dr. Rush has termed 
the disease an apoplexy of the lungs. Emetics in such cases restore 
a more equal circulation, and with the discharge of much mucus, the 
patient experiences much relief. 

In the Typhus Pneumonia, which pervaded so large a portion of 
our country, several years ago, and which deprived us of several or- 
naments of society, Emetics, judiciously administered, were found 
very beneficial. It was, Dr. Potter observes, a novel spectacle to 
those who were accustomed to unsheath the lancet, in almost every 
thoracic affection, to behold a pnuemonic Fever removed by the in- 
cantation of a single Emetic. 

In Asthma, given before the formation of the paroxysm, they very 
often suspend the attack. After the disease is formed, full and free 
vomiting, does much to effect the solution and bestow relief. From 
the extreme difficulty with which the blood passes through the pul- 
monary circulation, the large vessels in the neighbourhood of the 
heart are tumified and enlarged, the extremities are cold, and shrivel- 
led, the pulse is frequent, quick, and often small, a distressing cough 
is present, and an accumulation of mucus takes place in the bronchia, 
which from its viscidity, and the inability to expand the lungs, cannot 
be expectorated. Under these circumstances Emetics appear to exert 
a centrifugal power. The concussion the system undergoes by the 
action of vomiting, drives the blood into the remote parts of the 
body ; by the nausea they produce, spasm is relaxed, and expectoration 
by the rapid passage of the air in the lungs, through the bronchia, is 
promoted. 

In Pertussis or Hooping-cough, they are very effectual remedies, 
in the first stage. If the symptoms are violent, they should be re- 
peated daily, and sometimes twice a day, at least in children, for older 
persons cannot bear the repetition so well. The antimonials are 
commonly preferred, but some employ the Vitriolum Album, upon 
the supposition, that it is both Emetic and Antispasmodic. Dr. 
Fothergill recommends the antimonial preparations, and declares, 
that the practice of emptying the Stomach frequently, has been the 
means of affording most relief. 

In Cynanche Trachealis, or Croup, Emetics are indispensable, and 
are equally successful in the inflammatory and spasmodic forms. Of 
the Emetics used, the Tartarized Antimony is to be preferred, from 
the certainty of its operation, and the permanency of its effects. 
With proper views of the Pathology of this complaint, we may ap- 
proach it with as much confidence of success, as any other to which 
the infant state is subjected.* In its commencement it is purely in- 
flammatory, but accompanied with spasmodic affection of the Tra- 
chea. In mild cases, they afford much relief to the symptoms, and 

* Chapman's Mss. Lectures. 



lxx. 

they may be repeated during the whole course of the disease, when- 
ever from increased excitement, or when from an increase of the se- 
cretion of the larynx and bronchia, any aggravation of the symptoms 
is experienced. In some attacks however, other measures become 
necessary, not only to arrest the morbid actions which are going on 
in the larynx and bronchia, but to render the system susceptible to 
the operation of these agents. The insusceptibility of the Stomach, 
to Emetics, is often exhibited in this disease, in a remarkable degree, 
insomuch that the largest doses of the most powerful, are often in- 
sufficient to occasion its evacuation. Blood-letting will be required, 
and it should be resorted to whenever the excitement calls for it, or 
whenever the Stomach cannot be roused by such doses of Emetic 
substances, as it is prudent to employ. The obstinacy of this organ, 
to be acted upon by these agents, is connected with the general ex- 
citement of the system ; and if a single bleeding be insufficient to 
renew its susceptibility, another will, and it should even be carried 
ad diliquum animi. This will rarely be found to fail, and the effect 
of the remedies conjoined, is often salutary, in the highest degree. 
We should not, however, discontinue our treatment with the evacua- 
tion of the Stomach, but large doses of Calomel will be required to 
operate upon the bowels. The cure will then be completed, by giv- 
ing a decoction of the Polygala Seneka. " The neutrality, which 
in common practice, is followed between the patient and the disease, 
seems to depend upon incorrect notions of the pathology of the com- 
plaint, and an idea that children cannot support such evacuations. 
The fact is children possess a remarkable tenacity for life, and they 
even appear capable of supporting bleeding, and other evacuations, 
better than adults. There is no doubt, that they have endured, what 
has destroyed persons more advanced in life — they have been found 
with their mothers buried under a hollow cone of snow, the latter 
dead, and the other still preserving life. They resist contagious dis- 
eases better than adults, they recover more rapidly from surgical ope- 
rations, and when their systems have been reduced by evacuations of 
any kind — from these facts, we should consider the condition of no 
child, absolutely hopeless."* 

In the various anginose affections, Emetics are of great utility. 
They, in my opinion, are particularly well adapted to the commence- 
ment of these diseases, and in my practice, I have derived more bene- 
fit from their use, than from any other species of evacuants. These 
diseases, strange as it may appear, are often intimately connected 
with the disordered condition of the Stomach. This connection will 
not appear more singular, than various other diseases, which are ad- 
mitted to have their origin in that organ — thus aphthae in children, are 
referred to the state of the Stomach and Alimentary Canal, and va- 
rious exanthematous disorders, have a similar origin. Emetics then, 

* Chapman's Mas. Lectures. 



lxxi. 

are not only useful by evacuating the Stomach, but they reduce in- 
flammation by the nausea they excite, and by the new determinations 
they produce. 

In Cynanche Maligna, they are of use, in bringing off a considera- 
ble quantity of acrid matter, which by getting into the bowels, might 
induce a Diarrhoea — an affection to be avoided by every possible 
means, as always adding to the debility, and endangering the life of 
the patient. 

In Cynanche Laryngaa, one of the most distressing forms of angi- 
nose disease which you will ever witness, not only from the sufferings 
of the patient, but the great mortality which attends it, Emetics are 
often highly beneficial. Dr. Armstrong speaks of them in the high- 
est terms, and states, that in five cases of this disease, he had exhibited 
the Tartarized Antimony, and sometimes combined with Ipecacuanha, 
in repeated doses, until free and frequent vomiting took place. No 
circumstance of his professional life, he says, ever gratified him more, 
that the great and sudden relief which the vomiting afforded — in re- 
ality it removed all the urgent symptoms at the time, and being exci- 
ted as soon as the slightest signs of stricture of the larynx returned, 
at last completed the recovery. 

Diseases in which most of the above effects of Emetics are com- 
bined. 

Emetics in many of the diseases of the head, have been thought 
beneficial. The connection which exists between the brain, and the 
condition of the Stomach, would render such practice, often judi- 
cious and safe. We know that there exists, a considerable sympathy, 
and that one responds with promptness, to the derangements of the 
other. The existence of pain, though severe to be borne, is a happy 
result, arising from our organization, since it admonishes us of the 
approach of disease, and bids a recourse to such means, as Providence 
has appointed for our relief. 

The sick head-aches of the studious, and the delicate female, con- 
nected as they are with acid eructations, nausea, are often effectually 
relieved, by mild Emetics. Tq these may be added, head-aches, and 
vertiginous affections, which have often similar connections, and are 
terminated by the same means. 

In an anomalous species of headache, occurring after blows upon 
the head, they have afforded much relief. I was acquainted with a 
gentleman, who in a rencountre, received a severe blow upon the 
head, with a wound of the scalp. The wound healed very favoura- 
bly, but in a short time, the gentleman was affected with violent 
headaches, insomuch that he thought the bones of the head would 
be torn asunder. The anti-phlogistic treatment was carried to its 
fullest extent by Dr. Physick, without benefit, the scalp was divided'by 
a crucial incision, with only temporary advantage, at last, recourse 
was had to Emetics, and with very great effect. 

The common impression, that Emetics cannot be resorted to, in 
cases of severe headaches, and vertiginous affections, is altogether 



lxxii. 

unfounded — experience proves the contrary, and every day convinces 
us, that the brain supports the operation of Emetic medicines, 
under these circumstances, without injury. Witness the apoplectic 
state of intoxication, and let me ask, is it not wonderful, what a de- 
gree of compression, and determination of blood, the brain will some- 
times support, and yet return to the healthy exercise of its functions. 

In the apoplectic state of intoxication, an Emetic will effect much 
in restoring the patient to his senses. Not only in the apoplectic 
state, will relief be afforded by their use, but in the excited state 
which precedes collapse. Here when persons are noisy, quarrelsome, 
incapable of being controuled, breaking and destroying every thing 
within their reach, vomiting will put an end to all these irregular ac- 
tions, and if effected by an active Emetic, (here prefer a solution of 
Tartar Emetic in water,) the person by its operation is soon made 
more rational, and falls into a sound sleep. The beneficial operation 
of this practice, with its influence upon the moral faculty, in exciting 
disgust, should be a reason for subjecting every drunkard, to this treat- 
ment. 

In apoplexy, they have been recommended by the physicians of 
Europe. Their use in this disease, should be regulated with caution, 
and directed with judgment. In Idiopathic Apoplexy, that is when 
it arises from the general fulness of the system, I doubt if they could 
be safely resorted to, from the known tendency of the operation of an 
Emetic, to drive the blood to the superior parts of the body. But 
when the disease is symptomatic, or dependant upon the condition of 
the Stomach, which sometimes happens, they may be resorted to 
with advantage. In this case, it usually succeeds to a debauch, or 
from eating a very full meal, and under these circumstances their use 
is strongly indicated. Their administration, will with propriety be 
preceded by V. S., in order to reduce the volume of the blood. " That 
apoplexies frequently arise from this cause, I need only refer to the 
numerous instances of sudden deaths, that are mentioned in the daily 
papers, nothing being more common than the statement, that such a 
one dropped from his chair, after eating^a full meal. The effect of a full 
meal, distending the Stomach, seems to act by pressing upon the aorta 
descendens, and obstructing the free expansion of the lungs, by which 
means, the arteries of*the head become turgid with blood, and the 
disease produced." — Fothergill. 

To remove therefore, this determination to the head, active Emetics 
are indispensable, and they should be carried to the extent of free 
evacuation, for in proportion as this takes place will be the relief af- 
forded. 

In Epilepsy, there has existed a great variety of opinions respecting 
their utility. There are many cases in which this disease may be 
traced to derangement of the Stomach and intestines. This is ren- 
dered probable by the circumstance of its recurrence ; it being observed 
to make its attack in epileptics, upon any irregularity in diet — to 
occur very often among children who are much indulged, and that its 



Ixxm. 

attacks were seldom renewed, without either an habitual indulgence 
in eating, or a neglect of necessary exercise. It is therefore probable, 
that the state and condition of the Stomach, and Intestinal Canal, 
are greatly concerned in the production of this disease. We know 
that the irritation from worms, often excites this complaint, and why 
not irritation from the morbid or undue quantity of the contents of 
the Stomach. That such is the case, we infer from the relief afford- 
ed by an Emetic, administered during the paroxysm, either in mod- 
erating its violence, or bringing it to a close. Whatever doubts 
may exist as to the propriety of giving an Emetic, during the par- 
oxysm, most practitioners concur in their utility, previous to the fit, 
when from any particular symptoms, this can be foreseen. Dr. 
Eberle states, that in a child who had been eighteen months affected 
with occasional epileptic convulsions, he had succeeded in removing 
the disease entirely, by a long course of Emetic remedies, administered 
every third day. 

There is one other form of disease, which may with propriety be 
placed under this head, in which Emetics are useful : — the Convulsive 
Diseases of Children. 

These affections are always alarming, and with those of tender 
years in a more especial manner. They originate in various causes, 
often dentition, sometimes as a consequence of Fevers, and very often 
fronj irritating matter in the Stomach. When neither of the above 
causes exist, I am led to suspect the latter, and direct my treatment 
accordingly. I have been called to several cases, in which my sus- 
picions have been fully verified. In one instance, the little patient 
had been eating freely of ground-nuts, and in others, the food of the 
preceding day remained undigested, having undergone the acetous 
fermentation, to a considerable extent. In these cases, the paroxysms 
have only been relieved by evacuating the Stomach and bowels, and 
no article is so well adapted, as Ipecacuanha, in the first instance, 
followed by the free administration of Castor Oil. In the alarm which 
these occurrences always excites with mothers, and the attendants, a 
variety of remedies are resorted to, with little effect. The warm bath, 
frictions, mustard plasters, volatile substances of various characters, 
assafoetida, &c, which are all resorted to, on these occasions, are only 
of secondary importance — Relieve the Stomach and bowels, and the 
convulsions speedily subside. There is no article so safe and effectual 
as Ipecacuanha given freely, since its operation is intended to be two 
fold, to evacuate the Stomach, and to cleanse the bowels. 

In many of the forms of Mania, Emetics have been favourite 
remedies, but they should not be employed, without some discrim- 
ination. In the acute states of the disease, which is denoted by 
great loquaciousness, flushed cheeks, wild and inflamed eyes, &c. 
their employment would only aggravate these symptoms, by increas- 
ing the the determination to the brain. On the contrary, our remedies 
should be of such a nature as would divert action from that organ. 
Nauseating doses, may with propriety be resorted to, as a means of 
10 



lxxiv. 

diminishing action, and producing relaxation. But in chronic Mania, 
and in another species of derangement, Melancholia, employed in 
these cases, as a chronic remedy, and repeated every other day for 
weeks, I have known productive of the most beneficial effects. In 
these affections, the Stomach is generally very torpid, and requires 
large doses. Not only is the Stomach insensible to impressions, but 
the whole system, insomuch that cold, parturition, &c, produce but 
little inconvenience or distress. With these views strong antimonial 
Emetics have been employed, with the nappy effect of rousing the 
patient from that state of mental and physical torpor, with which he 
is oppressed, restoring sensibility, and renewed susceptibility to the 
impression of remedies. 

In Mania a Potu, Emetics have been strongly recommended. We 
owe this practice to Dr. Joseph Klapp, of Philadelphia, who was in- 
duced to make trial of Emetics, from the opinion that the disease 
was gastric in its origin. This he inferred from the nature of the 
substances ejected from the Stomach, the appearances upon dissec- 
tion, and the effects which follow their operation. This disease af- 
flicts persons who have long been addicted to the intemperate use of 
ardent spirits. If from contrition for the past errors of their lives, or 
from an attack of sickness, they are suddenly deprived of their ac- 
customed stimulus, derangement very generally follows. The treat- 
ment which was formrely pursued, and is still, by many practitioners, 
is the employment of opium, in very large quantities, in order to ex- 
cite sleep, (the symptoms subsiding soon after sound sleep can be 
induced,) and the use of a cordial, and stimulating regimen. Under 
this plan of treatment, the patient is gradually restored, but the cure 
is often tedious and protracted. Dr. Klapp, from observing the effect 
which accidental vomiting produced in a case of this nature, was 
induced to make a trial of Emetics, and much success followed their 
use. This practice was introduced by Dr. Klapp in the Pennsylvania 
Alms House, at the time I was a resident student in that Institution. 
Patients, who were admitted in the highest state of excitement, with 
every characteristic mark of the disease, as well as others, under the 
milder shades which it assumes, were speedily tranquilized under 
the operation of the Tartarized Antimony. If the administration of 
one Emetic was not sufficient to enthrone the reasoning faculties a 
repetition of them, provided the strength would admit, seldom failed. 
The consequences of the operation of the Emetic, was a discharge 
of thick, viscid, and glairy matter, a removal of the usual tremor 
the pulse becoming fuller and more frequent, and the patient soon 
falling into a sound sleep, from which he commonly awoke restored 
to reason, and to himself. As, however, he will complain of weak- 
ness, from the evacuations he has undergone, it will be proper to ad- 
minister moderately stimulating drinks, which confirm the cure. 
The Stomach, in this disease, loses its susceptibility to the action of 
medicines in a very great degree, insomuch that I have known a 
scruple of Emetic Tartar exhibited, before vomiting was produced. 



lxxv. 

It should therefore be given in doses of 2 grains, every 15 minutes, 
until it operates. It must, however, be observed, that this plan of 
treatment is not adapted to all cases. In some the constitution is so 
much broken down, by excessive indulgence, that it would be prostra- 
ted under this practice, and I would caution you against its employ- 
ment. Where, however, the strength of the pulse, and the vigour of 
the constitution will admit of it, you will find its effects extremely 
satisfactory, not only more speedily restoring the patient than by the 
the stimulating plan of treatment, but in rendering the system much 
more alive to the operation of stimulants. 

In Haemorrhages, Emetics have been employed. 

In Hemoptysis, they have been recommended by several physicians, 
particularly by Dr. Roberson, of Dublin. The practice I should 
not consider safe in this affection, and would strongly dissuade from 
any attempt to check the discharge of blood, by a recourse to these 
means, and hemorrhages from other organs are more effectually con- 
trouled by other remedies. 

In some local diseases, Emetics have been recommended. The 
state of nausea, with the diminished action of the heart and arteries, 
and the muscular relaxation which precedes the operation of Emetics, 
would entitle them to an attentive consideration in the treatment of 
obstinate Dislocations. It is well known to you that this state of re- 
laxation has been attempted by other means, as by venae sect., baths, 
cathartics, and by local application to the parts. Cases may occur 
in which one or any of those means would be objectionable, and re- 
course may be had to the administration of an Emetic. I should 
consider it decidedly more advisable, than any other of the proposed 
methods of procuring relaxation, as the object is obtained to as full 
an extent, without impairing the general health of the patient. All 
that is to be done is, after ineffectual attempts at reduction, to continue 
the extending and counter-extending bandages in their situations 
and to administer 4 or 5 grains of Tartarized Antimony. The patient, 
will soon complain of a desire to throw up, and shortly after of a 
disposition to faint. With this sensation approaching, the muscles 
which had before been hard and tense, become soft and flaccid, 
when a slight force applied will succeed in reducing the luxation. 

There are some other local complaints, in which Emetics have been 
employed with good effects, these are Hernia Humoralis, and in the 
suppurative stage of Buboes, &c. 

The catalogue of diseases is still incomplete, in which Emetics 
may be advantageously used. I have only selected the most impor- 
tant, and from the principle being so fully pointed out, on which their 
good effects depend, I suppose you can be at no loss in determining 
upon their propriety or impropriety. There are certain states of the 
system in which they should be used with caution — These are during 
the latter months of pregnancy, or when hernia, or prolapsus uteri 
exist. 



lxxvi. 

Individual Emetics. 

The articles in this class, have been variously arranged by writers 
on this subject. 

The division which I shall adopt, and which is recommended by 
its simplicity, is into the Vegetable and Mineral Emetics. Of the 
former class, no article is more deserving attention than the Ipeca- 
cuanha. 

Family Rubiacece. Calycocca Ipecacuanha.* 
Natural History — The genus of plants from which this root is 
derived, was not well ascertained, until Professor Brotero, published 
in the Linnean transactions, a description of the plant, accompanied 
with a plate. It was then distinctly ascertained by the botanists, 
that the genuine Ipecacuanha of the shops, is the root of a Pentan- 
drous plant, the Cephaelis Ipecacuanha of some, and the Calycocca 
Ipecacuanha, 'of other Botanists. 

The Natural History of this plant, was for a very long time in- 
volved in much doubt and obscurity. For nearly one hundred and 
fifty years after its properties were known, its characters were unde- 
termined. Linnaeus, in his 3d volume of Amenitates Academics, gave 
it as a specific name, to a species of Euphorbia, which grows plenti- 
fully in this country. He afterwards gave the same name to a spe- 
cies of viola. 

Decandolle also fell into the same error, and says that there are 
three species of viola, which produce the white Ipecacuanha. 

In the year 1781, Mutis, then travelling in South America, sent a 
specimen in full flower to the younger Linnaeus, who judged it to be 
a species of Psychotria — a genus formed by his father, for two or three 
plants that are native of the East and West Indies. 

In 1763, Dr. Woodville was favored by Sir Joseph Banks, with a 
specimen preserved in spirits, which had been sent from Brazil — a 
drawing taken from it was engraved and published in his Medical 
Botany. It was without a flower, but as its root was entire, there 
was no doubt of its being the real plant. Its genus still remained in 
a state of uncertainty, for Dr. Woodville was of opinion, that he 
could not follow the authority, on which Mutis received his infor- 
mation. We are therefore much indebted to Professor Brotero, for 
his satisfactory monograph on the subject, which was read before 
the Linnsan Society in 1801, and from an engraving in the Linnaean 
Transactions, the drawing which is exhibited is taken. 

Botanical description. — Root — simple or a little branched, roundish 
from 2 to 4 inches long, 2 or 3 lines thick, irregularly bent, brown 
without, divided into numerous prominent, unequal rings of an acrid 
bitter taste, but scarcely any smell. 

Stem — shrubby, sometimes creeping at the base, about the thickness 

» The word Ipecachuana is derived from the Peruvian— Ipi, root, a nd Cacuanha, 

the name of the district in which this particular root was first discovered so that 

the name simply means the root of Cacuanha.— Thompson. 



lxxvii. 

of a quill, giving out roots at the knots, and producing one or two 
new stems, about half a foot from each other. 

Leaves — from 4 to 8, near the summit of the stem, opposite, spread- 
ing, 3 to 4 inches long, 1 to 2 broad, entire, deep green. 

Flowers — aggregate in a solitary head, peduncled, terminal and 
rather drooping. 

Florets — sessile from 15 to 24, inclosed in an involucrum, 4 to 5 
leaved. 

Calyx — 5 cleft. 

Corolla — monopetalous. with 5 acute recurved segments. 

Stamens — five. 

Style — thread shaped— germ, egg shaped. 

It is a vivacious plant, which flourishes in moist, and shady 
places, in the woods of Brazil, of Pernambuco, Peru, and other 
parts of South America. The roots present in their external appear- 
ances, and their chemical composition, varieties, which have caused 
them to be distinguished into several sorts. Two varieties are 
found to exist in the shops of the Apothecaries, the ash, or grey, 
and the brown Ipecacuanha, and it is commonly thought that they 
are derived from distinct plants. The one, the Calycocca Ipecacu- 
anha, and the other the Psychotria Emetica. 

The researches of M. Merat have shewn, that these roots are de- 
rived from the same plant, the Calycocca Ipecacuanha, and the dis- 
tinctions observed, depend probably upon the nature of the soil in 
which it grows, or the time of the year at which it is collected. As 
it is received, it is a small wrinkled root, variously contorted, and 
marked, externally brown, and internally white, having a faint smell, 
and a bitter, slightly acrid taste. 

The root consists of a cortical, and medullary part ; and from ex- 
periments it appears, that it is in the former chiefly, that its Emetic 
qualities reside. * 

Ipecacuanha was brought into Europe, about the middle of the 
16th century, but it did not come into general use, until about the 
year 1686, when Helvetius under the patronage of Louis XIV. in- 
troduced it into practice, and was rewarded by his patron, with 
£1000 sterling for the discovery. 

Chemical History — To the researches of Pelletier and Magendie 
we are indebted for a complete analysis of this article. 

They have discovered in Ipecacuanha, the existence of Gum, 
starch, an extractive matter, an oily matter which possesses great 
acrimony, and of a penetrating odour, which acts with activity upon 
the tongue and palate, but which does not occasion vomiting.* 

They have also discovered a new principle to which the term 
Emetine has been applied, because in it resides the emetic property of 
Ipecacuanha. When it is dried it assumes the form of transparent 
scales of a reddish brown color — it has scarcely any smell, its taste 
is a little bitter, sometimes acrid, but not nauseous. 

* In this oily matter the peculiar odour of Ipecacuanha resides. — Pereira. 



lxxviii. 

Exposed to the air, it undergoes no other alteration but that of de- 
liquescence from absorbing moisture. 

It dissolves in water, without any alteration in its properties, but 
acetic acid is on its best solvents. The analysis therefore, of the 
Cortical part of the ash ,or grey Ipecacuanha, presents us with the 
following principles and their proportionss. 

Emetine, 14 parts — oily matter, 2 parts — gum, 16 parts — Starch, 
18 parts — ligneous matter, 48 parts — loss, 2 parts — 100. The analy- 
sis of the woody part, affords only 1-15 of Emetine, in 100. 

Analysis of Emetine — Carbon, 64-57 — Hydrogen, 7-77 — Nitro- 
gen, 4-30— Oxygen, 22-95—99-59. 

Preparation of Emetine — The powdered Ipecacuanha is treated 
with aether, in order to dissolve the fatty odorous matter of the Ipeca- 
cuanha, and when this solvent has ceased to act, the powdered sub- 
stance is itself exhausted by means of Alcohol. The alcoholic 
tincture is then evaporated in a sand-bath, and the extract dissolved in 
cold water, when it abandons some wax and a little remaining fatty 
matter. It remains now only to macerate it with some Carbonate of 
Magnesia, which deprives it of the gallic acid, and then to re-dissolve 
it in alcohol, and evaporate to dryness. The Emetine thus prepared 
is not entirely pure, but undergoes other processes to bring it into this 
state, being then white, pulverulent, unalterable by exposure to the air 
— the former article bearing the same relation to the pure, that brown 
sugar does to chrystalized white sugar. 

Operation of Emetine — Emetine is much more active than Ipeca- 
cuanha, and possessing few of the disagreeable qualities of that ar- 
ticle, may on all occasions be substituted for it with advantage. In 
dogs and cats, half a grain to 3 grains introduced into the stomach, 
produced vomiting, followed, sometimes with great disposition to 
sleep, and return to health, after a longer or shorter lapse of time. In 
larger doses, as ten grains, the vomiting is related, and the animal in- 
stead of returning to a state of health, after the soporific effect is 
over, dies ordinarily in twenty-four hours. 

Upon the human subject, 4 grains in two doses, taken at an inter- 
val of quarter of an hour, produce full vomiting, which is followed 
by a marked disposition to sleep. 

The application of Emetine is the same as Ipecacuanha, and when 
given to excite vomiting, it will be proper not to administer it in a 
single dose, as the Emetine being very soluble, and not adhering to 
the coats of the stomach, it would be thrown up at the first vomiting, 
which would then cease. 

It will be necessary to give it in repeated doses, and the best form is 
to dissolve 4 grains in fiv. of water, sweetened with syrup, and to 
which some aromatic water may be added. It has been recommen- 
ded by the French Chemists, as a substitute for Ipecacuanha, on ac- 
count of its more pleasant taste, its small bulk, and its ready solubil- 
ity in water, and on these accounts the discovery of Emetine, is a 
valuable one, this article possessing in a concentrated state the proper- 
ties of Ipecacuanha. 



lxxix. 

Solvents of Ipecacuanha — The active matter or Ipecacuanha, is 
extracted by several menstrua, by proof spirits, by wine, by vinegar. 
By boiling, the strength is lost, the active matter being dissipated ; 
and that it is of a volatile nature is proved by this circumstance, that 
if a decoction be made, while the substance loses its strength, yet the 
fluid is not impregnated with it. 

With wine, is formed the neat preparation, the Vinum Ipecacuanhee 
of the Dispensatories, and it is sometimes substituted for the powder. 
It is well suited to children, and is often resorted to in their cases. 

The strength of the powder is much impaired, by exposure to the 
light and air. 

The application of Ipecacuanha to Disease?. 

Ipecacuanha is the most important of the vegetable Emetics, both 
for its mildness, efficacy, and the promptness of its operation. It is 
less powerful than the preparations of antimony, and not so speedy in 
its action as the Sulphate of Zinc. 

It is therefore adapted to a variety of cases in which neither of 
these preparations could properly be employed, and produces effects, 
which could not be obtained from any other Emetic we possess. It 
evacuates the contents of the Stomach, without extending its action 
beyond this organ, and is therefore well adapted to cases where it is 
necessary to free the stomach from impurities, and when the dimin- 
ished strength of the patient would forbid the risk of active Emesis 
taking place. 

It is also from the mildness and certainty of its operation, well 
adapted to the diseases of children. 

In full doses, however, besides evacuating the contents of the Sto- 
mach, the action of the duodenum is inverted, and discharges of bile 
are produced. 

The activity of Ipecacuanha is proportioned to the largeness of the 
dose, though in a less degree than other Emetics, owing to the bulk 
and partial insolubility of the powder, a great portion is thrown off 
with the first efforts to vomit. 

Its action, however, is much increased by combination with Emetic 
Tartar or Calomel. 

It should be understood therefore, that when full and frequent vomit- 
ing is required, not only to evacuate the Stomach and duodenum, but to 
break up morbid associations, and to bring other parts of the system 
into sympathetic actions, we must have recourse to other Emetics, and 
particularly the mineral. 

But it is not only as an Emetic that Ipecacuanha is prescribed : it 
is advantageously employed in a variety of diseases. 

In the complaints of the Alimentary Canal, it has been much cel- 
ebrated. 

It was originally introduced with the character of an almost infal- 
lible remedy in Dysentery, and other derangements of the Intestinal 
Canal, and it probably has not lost reputation by time. 

In these cases, after the contents of the Stomach and bowels have 



Ixxx. 

been freely evacuated, it almost always produces good effects, in small 
doses, either alone, or in union with opium. It has been said to be 
particularly adapted to those cases where there is a great discharge 
of blood, but it is useful in any form, especially if there is much pain 
and tenesmus. 

Of its modus operandi, we are not more informed in this instance, 
than in others connected with the operations of medicines. Different 
opinions are entertained, but the most plausible is that of Dr. Moseley, 
who thinks that it acts by its sudorific operation, by which the fluids 
are determined to the surface. Whatever the theory may be upon 
thi^ subject, of this I am certain, that in most cases the union of Ip- 
ecacuanha with small portions of opium, relieves the griping and ten- 
derness of the bowels, promotes perspiration, checks the discharges of 
blood, and is upon the whole, one of the best combinations in this 
deranged state of the Alimentary Canal. It should not be resorted 
to, until the bowels have been well evacuated, and arterial excitement 
has been subdued. 

In Diarrhea, either in the recent or chronic stages, it is also equally 
efficacious, employed in the same manner, and with proper attention 
to regimen, most cases will be found to yield. 

In habitual Diarrhea accompanied with great weakness and irri- 
tability of the bowels, Ipecacuanha will be found to succeed after 
other remedies have failed. 

In these cases, it is recommended to begin with doses of 1 \ to 4 grs. 
in the morning. This will sometimes act as an Emetic, with biliary 
evacuations, sometimes it proves Cathartic, and gives a few motions 
downwards — at night an anodyne should be given, if there is nothing 
to forbid it. 

The Ipecacuanha is to be repeated or omitted the next morning, 
according to its operation the preceding day — if it has been consid- 
erable it should be omitted till the morning following, but the ano- 
dyne is to be repeated at bed time. A few doses, with proper attention 
to regimen, is commonly sufficient to restrain these discharges. In 
this manner, by its evacuating operation, it cleanses the Stomach by 
vomiting, or the intestines by acting as a purgative. It does more — 
it acts a Diaphoretic, the perspirable matter being thus discharged 
by those emunctories through which it ought to pass, and the bowels 
relieved of a quantity of acrimonious fluid, the presence of which 
aggravates, if it is not the most frequent cause of such complaints. 

In Dyspepsia if has also been recommended very highly. It is to 
be given in such doses as will not excite any painful sensations of 
nausea, but sufficient to produce a slight action upon the Stomach, by 
which its viscid contents are separated and expelled from that organ. 

There are some people who can take to the amount of two grains 
without nausea, and others who cannot take more than a third or 
fourth part of a grain. It is therefore proper to begin with a small 
dose, and to augment it gradually (if it is necessary) to the point at 
which the action of the remedy begins to be felt. Some persons pre- 



Ixxxi. 

fer giving the Tincture of Ipecacuanha, in doses of a few drops 8 or 
10 drops, 2 or 3 times a day. 

The effect of this medicine is in some degree alterative, as it pro- 
motes the secretion of the gastric juice, and excites the action of the 
Stomach, two objects of considerable importance to be gained in the 
treatment of this disease. — Memoir by M. Daubenton. 

Ipecacuanha has been employed in Heemorhages of every descrip- 
tion. In Haemoptysis it has frequently been employed in nauseating 
doses, and it is said to be equal, if not superior, to the Sac. Saturni 
in these cases — care must be taken, however, that vomiting is not 
excited, otherwise bad consequences would be likely to ensue. 

I am aware that vomiting has been recommended by some physi- 
cians in this disease, and has in some cases been known to put a stop 
'to the further discharge of blood ; but in others it has increased the 
haemorrhage to a great and alarming degree, and the possibility of 
such an accident, should render us cautious in the use of the remedy. 

In Uterine Haemorrhage this medicine also exhibits good effects. 
Given in small doses of half a grain every half hour, it has succeed- 
ed in the hands of Bergius and others in restraining severe dischar- 
ges of blood from this organ. The operation of Ipecacuanha, is 
more intelligible in restraining Haemorrhages than in other cases, and 
that without attributing to it astringent or antipasmodic properties, as 
has been asserted by some writers. It seems to act by exciting 
nausea, which when produced, has a great effect in diminishing the 
action of the heart and arteries, and lessening the impetus of the 
blood. 

To this we may add its equalizing the circulation and exciting a 
discharge from the cutaneous vessels, In these Diseases it is em- 
ployed in doses of half a grain to 2 grains, every 3 or 4 hours, either 
alone or combined with opium. 

Besides these diseases, Ipecacuanha exerts an action on the Mu- 
cous membrane of the Bronchia and Fauces, which renders it of ser- 
vice in Catarrhal and Pneumonic disorders, and in the different states 
of these complaints, it exerts a diversified and seemingly opposite ac- 
tion, not only promoting expectoration in cases where the mucous 
membrance is inflamed and dry, but likewise serving to restrain the 
secretion when it is inordinate and excessive. — -Bigelow. 

In Asthma an Emetic affords great relief, and this not only from 
the benefit which the mechanical operation of vomiting would pro- 
duce, in enlarging the cavity of the Thorax, removing the congestion 
of the lungs, and expelling the viscid mucus which collects in the 
Bronchia and Trachea, but from an antispasmodic operation exercised 
by the article itself. This last mode of operating I cannot admit, 
though supported by the authority of Akenside, the poet as well as 
physician. From a frequent trial of it, in these cases, I do not think 
that it possesses any advantages over other Emetics, which I have 
employed for the same purpose. 

It was the practice of the same gentleman, to continue the Ipeca- 
11 



lxxxii. 

cuanha, in doses of 4 or 5 grains every morning in the intervals, to 
excite nausea, with a view to a permanent cure. This practice I 
have imitated, though not in as large doses, and with effects which 
have been highly gratifying. It was administered after other means 
had been unavailing, in doses of a grain, combined with Liquorice 
powder, every two hours during the paroxysm, and in the intervals, 
night and morning. By this means the paroxysm has been much 
moderated, and the patient been able to resume his duties as a me- 
chanic. In another case now under treatment, in which the dis- 
ease had continued for several months resisting a variety of remedies, 
the Ipecacuanha in similar doses night and morning bids fair to ac- 
complish more than has yet been affected by other means. 

Ipecacuanha combined with opium, and a portion of the Sulphate 
of Potash, forms the very valuable Diaphoretic called Dovers Pow- 
ders. United to purgative medicines in nauseating doses, it gives to 
them greater activity, and may occasionally be joined with them, 
when the determination to the surface is also required. 

Incompatible Substances. — The substances which weaken or des- 
troy the powers of Ipecachuanha, and therefore called Incompatible, 
are all Vegetable Astringents, as infusions of galls, green tea, &c. T 
the vegetable acids, as the acetic. 

It may not be improper to notice the action of i Gallic acid upon the 
active principles of Ipecacuanha. This acid precipitates Emetine 
from its solutions either aqueous or alcoholic, and contracts with it an 
intimate union, which changes its nature, and takes from it its Emetic 
property. In those cases therefore, where it has been given in too 
large a dose, and where it exerts violent effects, nothing is easier than 
to destroy its activity, it being only necessary to administer a decoc- 
tion of galls, or a strong infusion of green tea. 

Messrs. Pelletier and Magendie, have tried upon themselves the 
power which this decoction possesses of neutralizing the activity of 
Emetine. 

The same means are of course sufficient, where it is necessary to 
blunt the effects of Ipecacuanha. 

The powder and solution are the forms of exhibiting Ipecacuanha. 
The former is the most energetic, although the vinous solution is both 
active and convenient. A 

The medicinal operation of Ipecacuanha, varies with the dose. 
Thus 10 to 30 grains, act as an Emetic — 1 to 4 grains, as a Diaphor- 
etic, in smaller doses as the one fourth to half a grain, Alterative and 
Expectorant. 

Combined with opium its Diaphoretic property is increased as 
already observed. 

Upon the Doses of Medicines. — I may make this general remark, 
which I hope will be recollected, whenever the subject is alluded to, 
that large and small doses of medicines are merely relative terms, 
and should never be understood as denoting absolute quantities, for 
what would prove a large dose in one person, might prove trifling in 



lxxxiii. 

another. I have had occasion to give as much as fss of the tincture 
of Digitalis, in twenty-four hours, and this continued for several days, 
before its effects upon the system were produced. Dr. Cartwright, in 
the Pneumonia Biliosa, of Natchez, has employed the Tartarized 
Antimony, with great advantage, but has found it necessary to ad- 
minister from 16 to 20 grains in divided doses, before its effect was 
produced on the system. 

The general rule of conduct, ought to be derived from the sensible 
effect of our practice. Every dose of medicine, however large, is too 
small if it stop short of the usual sensible operation on the constitu- 
tion. This is to be the rule in the use of medicines — the system is to 
be placed fully under their influence, and when this has been done 
without effect, the remedies must be changed for others. Were this 
general rule more closely attended to, we should not so often complain 
of the inertness of our means, or the obstinacy of diseases. Disease 
and Debility are kept up by what is called. cautious practice. Prac- 
tice which is regulated rather by the quantity of prescribed medicines, 
than by the effects produced. 

Adulterations of Medicines. 

While upon this article, I shall take occasion to put you on your 
guard in selecting medicines, and to remind you of the unpardonable 
adulterations, too frequently practised. There are perhaps few articles 
upon which ingenuity has been more exercised, to impose upon the 
credulity of mankind, than the present. Of the various substances 
which have been sold for Ipecacuanha, I will merely mention a few. 
The roots of the Gillenia Trifoliata, the Euphorbia Ipecacuanha, and 
the Phytolacca Decandria, or Poke, have all been sold for this article. 
The roots of Sarsaparilla, have been powdered and combined with the 
Tartarized Antimony in imitation of the Ipecacuanha. 

The frequency with which these adulterations are practised renders 
it necessary to mention to you, that it is not advisable to purchase 
large quantities of any medicinal substance in powder, and as frauds 
are often committed in a manner to elude detection, I would advise 
that whenever it is practicable, to procure as many of your medicines 
in the root as is possible. I could inform you of adulterations of other 
articles, which would excite surprise to a great degree, particularly 
in the common article Peruvian Bark. In Gray's supplement to the 
Pharmacopoeia, may be seen a recipe, for the formation of a facti- 
tious Peruvian Bark, consisting of Peruvian Bark, Mahogany saw 
dust, and oak saw dust ground together. Powdered Gypsum has 
been sold for Cream of Tartar. In Boston, the occupant of a wind 
mill was indicted for grinding Gypsum into Cream of Tartar. 

I shall therefore on all occasions point out to you the frauds which 
are committed with medicines, and by presenting you with the best 
specimens of the article treated of, so familiarize you, with their sen- 
sible properties, as to enable you to discover villainy, in this most foul 
of all its practices. 



lxxxiv. 

Nearly allied to Ipecacuanha in its properties and uses, is the na- 
tive article, the Spiraea Trifoliate vel Gillenia Trifoliata or Indian 
Physic. 

It grows plentifully in various parts of the United States, and in 
the upper districts of this State, flowering in June and July. The 
root is the only part employed, though the stems possess the same 
properties. 

Description of the Plant. 

N. Family Rosacea. — Class Icosandria, Di-Pentagynea. 

Calyx — tubular, campanulate, border 5 toothed. 

Corolla — partly unequal, petals, 5. 

Stamens — 20, and small, styles 5. , 

Leaves — ternate, lanceolate, serrate, stipules, linear, entire. 

Stem — herbaceous, 1 to 2 feet high. 

Root — perennial, small, slender, and irregular, divided into many 
parts, and furnished with an infinity of small fibres. The roots re- 
semble in structure, colour, size and taste, though indistinctly, the 
common Ipecacuanha of the shops. 

They generally run a little distant from, and sometimes very 
near the surface of the earth, in various directions, similar to Ipeca- 
cuanha. 

They are composed of a cortex or bark, and ligneous substance. 

The cortex or bark is made use of in medicine, and the Emetic 
property resides principally in this part, though the ligneous matter is 
not without activity. 

The root, the part used, is best given in powder, when it will prove 
a certain and manageable Emetic, and jat the same time perfectly safe 
in its operation. True it is, that it will not produce those convulsive 
contractions, which arise from the Mineral Emetics, but in mild cases 
requiring the employment of Ipecacuanha, it may with advantage be 
substituted. 

As it is nearly allied to the Ipecacuanha in its character and opera- 
tion, it may be employed in the diseases, in which that substance ex- 
hibits its good effects. 

It has been experimented with by different individuals, and by Dr. 
De La Motta of this city, and found equal to Ipecacuanha, in its 
Emetic operation, and its application to the ordinary diseases in which 
that article is useful. 

The dose of the Gillenia, is 30 or 40 grains of the powdered root, 
which gives to Ipecacuanha a decided superiority, the bulk being a 
great inconvenience. This objection may be obviated by combining 
a grain or two of Tartarized Antimony with 15 grains of Gillenia. 



Family Euphorbia. — Euphorbia Ipecacuanha, Ipecacuanha Spurge, 
is another of the Vegetable Emetics, with which our country is en- 
riched. It grows well in the Middle and Southern States, and is 
peculiar to this country. The root is the only part used, and before 
we were better acquainted with the true origin of the officinal Ipe- 



Ixxxv. 

cacuanha, was supposed to be the plant from which that drug is ob- 
tained. 

Euphorbia, general character. — Nearly all the plants of this genus 
are remarkable for their activity, when applied to the human system, 
not only acting upon the Stomach and Alimentary Canal, when taken 
internally, but producing redness, tumefaction, and excoriation of the 
skin, when applied to the surface. They all abound with a milky 
fluid, which is discharged very freely when the plant is broken. 

Euphorbia Ipecacuanha — Is a low tufted plant, growing in sandy 
soils, in the Middle and Southern States, found in considerable quanti- 
ty in Colleton and Edgefield Districts. The root is large proportioned 
to the size of the plant, and runs very deep into the earth. 

The stems are numerous, erect and procumbent, forming large bran- 
ches on the surface of the ground. 

The leaves are inserted on the joints, opposite, sessile, smooth. 

The flowers are solitary, on long peduncles or foot-stalk, from the 
forks of the stem. 

The Euphorbia Ipecacuanha, is the most active of any of the Ve- 
getable Emetics I have enumerated, differing from them in having its 
action extended to the bowels, and operating as a cathartic with a 
considerable degree of activity. 

The testimony in support of its Emetic powers is sufficiently ample, 
Drs. Bigelow and Barton, considering it a safe, certain, and manage- 
able Emetic, applicable to most of the cases in which medicines of 
this kind are called for. 

The dose is from 15 to 20 grains. If the first does not operate, it 
may be repeated, but it does not admit of frequent repetition, since 
violent effects are sometimes apt to ensue. In this respect it differs 
considerably from the officinal Ipecacuanha, which admits of being 
administered in repeated doses, and of being accumulated in the 
Stomach, until its specific effect is produced, without any injurious 
consequences resulting. 

Euphorbia Corollata. — Of the same genus, and related to the fore- 
going in its effects, is the plant I present you. 

Its character is as follows — 

Root, large, branching. 

Stems numerous, frequently growing to the height of 2 or 3 feet. 

Leaves are scattered and sessile, oblong and obovate. 

The stem divides at the top of the plant into a large five rayed 
umbel, supported by an involucrum of as many leaves. The rays of 
the umbel are divided into two or three branches, supporting flowers. 
Upon breaking the branches, there flows out a milky fluid winch 
possessess very acrid properties. 

The root is the part used, and it is equally as active as the Euphor- 
bia Ipecacuanha, and might be employed advantageously as an 
Emetic. 

The dose of the powder is from 15 to 20 grains. It also frequently 
has its action extended to the bowels, operating upon them as a ca- 



Ixxxvi. 

thartic. These articles, besides their Emetic properties, are used for 
other purposes. 

In small doses of from 8 to 10 grains, they operate upon the bowels, 
and in smaller doses, as 2 or 3 grains, as a Diaphoretic, combined 
with opium, or the antimonials. 

I have employed these articles for their evacuant and Diaphoretic 
operation, and am satisfied that they may with safety and advantage 
be employed for these purposes. On several occasions I have had 
recourse to them, and consider them fully entitled to the consideration 
of the profession. Even should they not be employed, every physi- 
cian should be instructed in their properties, and when occasion re- 
quires, know the substitutes he can apply to in case of need. 

In concluding these articles I would recommend them to gentle- 
men practising in the country, little doubting, that with the precau- 
tions I have mentioned, they will be found valuable, and good sub- 
stitutes for the Ipecacuanha. Their operation seems exactly pro- 
portioned to the quantity taken, and the vomiting is not checked as 
in Ipecacuanha, by the powder being thrown off in the first efforts of 
the Stomach. 

Besides these articles, there are a variety of other plants which 
may be used as Emetics. It would be tedious to enter into their par- 
ticular consideration. A simple enumeration will be sufficient, and 
among them will be found plants which are familiar to you. 

They are, Sanguinaria Canadensis, or Blood root ; Lobelia Inflata, 
Indian Tobacco ; Aralia Spinosa, Prickly Ash ; Eupatorium Perfoli- 
atum, Thorough wort ; Stylingia Sylvatica, Glueen's Delight ; Erythro- 
nium, or Snake leaf; Phytolacca, Decandria, Poke. 



Upon the Lobelia, as much has been said of its virtues of late, a 
few remarks may be made. The common name by which it is 
known is Indian Tobacco. 

It is a biennial plant, and is found growing in most parts of the 
United States. The family of the Lobelia's is a very extensive one, 
and medicinal properties of great value have been ascribed to several 
of them. Some of the family are characterized by their very striking 
and beautiful appearance. 

The Lobelia Cardinalis, is probably one of the most showy and 
conspicuous flowers in our woods, and by being introduced into gar- 
dens, the care bestowed upon its cultivation is returned, in the greater 
number of flowers formed upon it, and their more brilliant appear- 
ance. 

The Lobelia Inflata, is the most active of any, and may be consid- 
ered among the most useful of our indigenous medicines. It is a 
small plant varying in height from six inches to two feet. 

The root is fibrous. 

Stem erect, much branched, angular. 

Leaves are scattered, sessile, oval. 

Flowers in spikes, each one in the axil of a small leaf. 



lxxxvii. 

Corolla, bluish purple. 

It exudes a milky juice upon being broken, and is found growing 
in the mountains and upper counties of Carolina and Georgia. 

The properties of this plant, are Emetic, Diaphoretic, Expectorant, 
and in some degree Narcotic. When taken in the form of infusion 
or tincture mixed with water, it has an acrid pungent taste — when 
swallowed it is followed by a sensation of roughness in the throat, 
with a prickling which continues some time. This impression being 
of a stimulating character fequently excites a copious secretion of 
salivary and mucous fluids, with hawking and a more free expecto- 
ration. In the Stomach hausea is excited, and when in large doses, 
vomiting frequently succeeds. 

As an Emetic it is not distinguished by any peculiarity of opera- 
tion which would render it particularly worthy of attention. On the 
contrary by its pungent irritating action upon the Stomach, and the 
violent effects which sometime follow its use, it becomes a more ex- 
ceptionable article than many which are employed, and which I have 
recommended. 

This article from its Expectorant, Narcotic, and often Emetic ope- 
ration, is frequently very useful in Asthmatic affections. Few dis- 
eases, without being dangerous, are more distressing. In my practice 
I have a dozen patients disposed to this affection, and from the expo- 
sure many of them are obliged to undergo, with every great change 
in the weather, attacks in some are brought on. Persons so pre-dis- 
posed become, I may say, living, barometers ; every change of wea- 
ther is sensibly felt, and where the comforts of life do not abound, 
paroxysms of Asthma frequently succeed. I have had occasion to 
try various remedies — venae sect., Emetics, Cathartics, opiates, antis- 
pasmodics, pectorals, counter-irritants — and though great relief is af- 
forded by some, and often all of them, yet it is often effected with 
considerable expense of the vital powers. This is a great objection 
in many cases, since the system is often much enfeebled by the fre- 
quent recurrence of these , paroxysms. I have for several years past, 
employed the Lobelia, and have derived more benefit from its use 
than from any other single agent. It has appeared to shorten the 
paroxysm, in some instances speedily, in others more slowly, and has 
even appeared to prevent their recurrence in others. In one case in 
which the disease continued an unusual length of time, threatening 
thus to become habitual, I had a fair opportunity of experimenting 
very freely. A variety of articles were employed with but temporary 
benefit, at length the lobelia was given, and without any inquiries 
being made of the comparative efficacy of the several means which 
had been used, the observation made by the patient was, that he had 
been more relieved by the Lobelia than by any thing else which had 
been tried. 

In the severest paroxysm which I have ever witnessed, complete 
relief was afforded, and the subsequent paroxysms greatly mitigated 
by a compound as follows 



lxxxviii. 

Tincture Lobelia. 
. Compound Syrup of Squills. 

Simple Syrup of Squills, each equal parts. 

A dessert spoonful was given every 10 minutes during the paroxysm, 
until relief was afforded. The patient has had no return of the dis- 
ease for nearly a twelvemonth. 

Forms of exhibition-^It may be given in powder, in tincture and in 
infusion. 

In Powder, the dose is from 20 grains to a teaspoonful, as an 
Emetic. 

The tincture should be prepared afresh every half year, as it loses 
much of its activity, by being long kept. The recent plant should be 
preferred. The dose of the tincture will vary from a teaspoonful to a 
tablespoonful — when designed as an Emetic, to be repeated every 10 
or 15 minutes — when its expectorant operation, every hour or two. 

The Infusion is rarely employed — with sugar or treacle a syrup 
may be formed, which may be advantageously used in the catarrhal 
affections of children, and in threatened croup. This preparation 
will be found more active than Squills, and more readily taken. 

In thus presenting you with various articles possessed of Emetic 
properties, I hope that their consideration will not be deemed useless. 
Many of them I admit are very inferior to the Ipecacuanha, but as 
this article is often adulterated, is purchased at a high price, and may 
not be in your shops when wanted, it becomes highly necessary that 
you should be acquainted with the substitutes about you. Many of 
these articles if more experimented with, would I have no doubt be 
found more valuable than they at present are thought to be, inasmuch 
as the doses would be better determined, the circumstances under 
which they should be used, &c. 

To assist you several works, as Bigelow & Barton, and Rafanes- 
ques' small work on Botany, may advantageously be referred to. 



Family Solanece. — Nicotiana Tabacum, Tobacco, is the next article 
of which I shall treat. This substance is not commonly placed under 
this class, as it possesses so many other properties — being Narcotic, 
Errhine, Sialagogue, Purgative, as well as Emetic. Possessing the 
latter property in a considerable degree, it may be proper to consider 
it under this head. 

Natural History. — Tobacco was not known in Europe until after 
the discovery of America, and was first imported about the year 1560, 
as some say, by Sir Francis Drake. 

The Spaniards who gave it the name Tobacco, took'it from Tobaco, 
a province of Yucatan, where they first found it, and first learned its 
use — or according to others, it derived its name from the Island of 
Tabago or Tobago. 

The French at its first introduction among them gave it various 
names, as Nicotiana from John Nicot the Ambassador of Francis II. 
in Portugal, who brought some of it from Lisbon, and presented it to 



lxxxix. 

Catharine de Medicis, as a plant of the new world, possessing extra- 
ordinary virtues. 

Previous to its introduction into France, it had been brought into 
England by Sir Francis Drake, and the custom of smoking in Eng- 
land is ascribed to Sir Walter Raleigh. Its power to excite a train 
of pleasing reflections, as well' as to calm the agitations of our na- 
ture, depends upon the Narcotic principle which it possesses. 

Chemical History. — Besides various principles, Tobacco contains 
a peculiar proximate one, upon which the properties of the plant are 
supposed to depend, and which has been called Nicotin. Vauquelin 
considers Nicotin as approaching the volatile oils in its properties — 
it is colourless, has an acrid taste, with the peculiar smell of Tobacco 
— and occasions violent sneezing. The Medicinal activity of Tobacco 
resides in this volatile part. Water, wine, alcohol, are there/ore sol- 
vents for the medicine. Long boiling dissipates its activity, so that 
the decoction and extract are weak preparations. 

The oil may be obtained by distilling the leaves, and separating 
it from the top of the water, upon the surface of which it will be 
found to float. This oil was found to destroy the life of cats and 
kittens and other animals almost instantly, in the small quantity of 
two drops, either by applying it to the tongue, or injecting it into the 
rectum. 

Medical History. — Tobacco is a well known drug, of a Narcotic 
quality, which it discovers in all persons even in small quantities when 
first applied to them. A small quantity snuffed up the nose has pro- 
duced giddiness, stupor, and vomiting, and when applied in other 
ways in a large quantity, there are many instances of its more vio- 
lent effects, and some of its proving poisonous. In these instances it 
operates in the manner of other Narcotics. 

Along with this quality it possesses also a strongly stimulant power 
upon the whole system, but especially upon the Stomach and intes- 
tines, so as readily, even in small doses, to prove Emetic and purga- 
tive. It has been used as an Emetic, and said to be particularly 
adapted to evacuate poisons, which produce a torpor of the Stomach, 
and which therefore requires some violent medicine to act upon it. 
As it possesses no peculiar good qualities, and as its operation is com- 
monly attended with much sickness, it has not, nor is it likely ever to 
come into practice with physicians. 

Externally applied, in the form of Cataplasm of the moistened 
leaves, it often rouses the Stomach and occasions vomiting. In this 
manner it has been employed with complete effect, to expel an inor- 
dinate quantity of laudanum, taken with a view to suicide, when 
other Emetics had failed. The cases, however, in which it is most 
commonly used is in obstinate constipation of the bowels, and in 
Strangulated Hernia, as an Enema, and the manner of preparing it 
is as follows — 

Fol. Nicotiana, 3!. 

Water, ibi. — simmer for a short time. 
12 



xc. 

One half to be used, and the other in an interval of half an hour, 
if necessary. It overcomes the obstruction, by the extreme relaxation 
it produces, and by its cathartic operation. It must, however, be used 
with caution, as several lives have been lost by too strong an infusion 
being thrown into the rectum. 

The smoke of Tobacco has been used for the same purposes, in- 
troduced into the rectum, and it is very powerful, owing to the activity 
of the volatile part of the medicine. It possesses some advantages 
over the Infusion, being milder and therefore more safe. 

Tobacco has also been employed, by Dr. O'Bierne, in the treat- 
ment of Tetanus, and much success is said to have followed its em- 
ployment. I am unable to furnish any details of the method pur- 
sued, the work not having reached this country. 

The manner in which Tobacco is used, is in the form of Enema, 
thrown into the colon, by means of a flexible tube introduced into the 
rectum. His practice he details in his work upon Defecation, and 
presents a list of twenty cases, eleven of which recovered. He ad- 
verts to the disease in the horse, in the treatment of which, his 
method in the hands of the veterinary surgeons, had been attended 
with success. 

United with Cerate in fine powder, it has been employed for its 
nauseating and relaxing operation in other Spasmodic diseases. 

In Cynanche Trachealis, or Croup, it is applied in the form of a plas- 
ter, to the upper part of the sternum. Cases of this disease have been 
treated after this manner and with very happy effects. Employed at 
the very commencement it has succeeded in arresting the complaint, 
and in conjunction with other means, has on other occasions been in- 
strumental, by exciting vomiting, to aid in very materially relieving 
the patient. 

Besides these diseases, it has been employed in Dropsies, as a Di- 
uretic, and by some Physicians it is stated, with considerable suc- 
cess. The manner in which it is used I shall speak of hereafter. 

The poisonous effects of Tobacco are more likely to follow its 
employment as an Enema, than as an Emetic. 

When an accident of this kind occurs, it is proper to know that the 
Infusion or the Tincture of Galls throws down the Nicotina and 
renders the Infusion of Tobacco inert, and consequently should be in- 
stantly administered. — Thompson. 



Family Asphodelece. — Scilla Maritima or Squills-Is a large bulbous 
plant belonging to the Lilly family, which grows on the sea coast, 
and of which the bulb only is employed in medicine. The bulb in- 
creases to a considerable size, and is composed of Tunics or coats in- 
closed one within the other. The exterior is covered with scales of a 
brownish colour, the interior tunics are white and fleshy, the exterior 
being sometimes tinged with red, without any perceptible odour, but 
abounding with a juice, viscid, bitter, and acrid. The scales are 



XCl. 

found in the shops separated the one from the other and dried. By 
drying the root it loses much of its acrimony, but it is still a very 
active medicine. 

It is brought to us from the shores of the Mediterranean, and is a 
native of Spain and Italy, and from its growing in sandy soils on the 
sea coast, it has the name of Maritima. 

The recent root is less active than the dry, in consequence of its 
containing a considerable portion of watery juice, which escapes in 
the process of exsiccation. 

Analysis of Squills. — M. Planche has discovered Tartrate of Lime. 
According to Vogel it contains when dried, gummy matter, a prin- 
ciple very bitter and acrid, which has been called Scillatine, and 
which is the essentially active principle — tannin, citrate of Lime, a 
sweetish substance. 

By. M. Tilloy it has been thought that the Scillatine of Vogel is 
not an immediate principle, but a mixture of uncrystallizable sugar, 
with a matter essentially acrid and bitter. It is white, transparent, 
of a resinous fracture, deliquescent, soluble in water and alcohol. It 
is obtained by subjecting the expressed juice to the action of alcohol, 
and in decomposing the alcoholic solution by means of the acetate 
of Lead. It is not used in medicine. 

Medical Uses. — The root of the Squill appears to have been known 
as a medicine in the very early ages of Greece, and was employed by 
the Egyptians in dropsy, under the name of the eye of Typhon. 
It has well maintained its character ever since, and is deservedly held 
in great estimation. 

The Squill possesses many and diversified powers, being not only 
Emetic and Purgative, but Diuretic and Expectorant, on which ac- 
count it is employed in many cases. 

In large doses it stimulates the Stomach and proves Emetic, but it 
is seldom used for this purpose, and its place is better supplied by 
other articles. 

In smaller doses its Diuretic properties are obtained — but I shall 
speak of these under that head — with its application to diseases. 

Squill yields its active properties, to water, vinegar, ardent spirits. 
The preparations in most common use are the powder, vinegar, and 
oxymel of Squills. The mixture of acid with the Squills renders the 
taste of Squill more supportable, and adds to its Expectorant proper- 
ties. 

Dose — Of the Powder, as an Emetic, is from 8 to 10 grains. 



Mineral Emetics. 

Having completed my description of the Vegetable Emetics, I 
shall next proceed to the second division, or those derived from the 
Mineral Kingdom — and at the head of these must be placed the pre- 
parations of Antimony. 



xcn. 

Antimony is a ponderous brittle mineral, or semi-metal, of a bluish 
white colour, of a shining surface, and striated texture. It is seldom 
or never found pure, but combined with sulphur, and is obtained from 
mines in Hungary, Germany, France, and England. The best is 
said to be brought from Hungary. Antimony, called Stibium by the 
ancients, receives its name from Basil Valentine, a German Monk, 
who gave it, as tradition relates, to some hogs, which after purging, it 
greatly fattened — thinking in like manner to feed his brother monks, 
all of them perished by the experiment — hence it was called anti- 
monk, and by corruption Antimony, from anti-monos. 

The preparations of Antimony, like most other active articles, 
found their way into the practice of medicine with great difficulty. 
Basil Valentine in the sixteenth century, 1576, first brought them into 
credit as internal medicines, and soon after published a work, setting 
forth their uses and their applications. From their occasional violent 
operation and the dangerous consequences which followed their inju- 
dicious employment, they fell into disrepute, and were denounced by 
the Medical Faculty of Paris as poisonous. They were, however, 
revived by Paracelsus, and by him employed as powerful and effica- 
cious remedies. After this they were alternately received and reject- 
ed, until by the labours of Hoffman, and still more Cullen, and 
Fordyce, they became established in regular practice, and are now 
ranked with the most valuable articles the Materia Medica affords. — 
Parrs 1 Medical Dictionary. 

Antimony in its native state, existing as a sulphuret, to which the 
term crude. Antimony is applied, exerts very little action, upon the 
human system.* 

To render it active it has been submitted to a variety of operations 
by the chemist, the consequence of which is, that the preparations of 
this article have been multiplied to considerable extent, and its phar- 
maceutical history is well understood. Differing as these preparations 
do in degrees of strength, they are characterized by a considerable 
uniformity in their action. On this account, I shall glance cursorily 
over them, and will only employ your time in commenting upon the 
most important. 

Preparations of Antimony. 

Antimony existing in its native state, combined with sulphur, owes 
its inertness upon the system to the large quantity of this article 
which enters into union with it. It is obvious that when this is sep- 
arated to a certain extent, (for when wholly separated as in the state 
of regulus, it is insoluble in the juices of the Stomach,) the more ac- 
tive it will become, and accordingly the different preparations from 
crude Antimony, depend upon the different proportions of sulphur 
which they contain, and the different substances employed for its sep- 
aration. 

* If the Stomach be acescent, it operates with violence — when there is little 
or no acid present, it produces scarcely any action upon the system. 



XC111. 

The different means in use, to give activity to Antimony, are — 

1. Trituration. 

2. The action of heat and air, — of these preparations none are re- 
tained in practice. 

3. By the action of the Alkalies. — Under this head is the Kermes 
mineral. This is prepared by boiling a solution of Potash, on Sul- 
phuret of Antimony, for a certain length of time ; — (three hours) — the 
liquor when strained and allowed to cool deposits a red colored powder, 
and is known by name of the Kermes Mineral, or the Sulphuretted Hy- 
droguret of Antimoiry, containing 2 proportions of Antimony, and 3 of 
Sulphur, called also a Sulphuret of Antimony, and a Sub. Hydro. Sul- 
phate of Antimony, according to the French. 

Nearly allied to the Kermes, is another preparation, commonly 
called the Golden Sulphur of Antimony. It is prepared in nearly 
the same manner as the former, except that the precipitate from the 
strained liquor, is thrown down when the mixture is warm, by diluted 
Sulphuric acid, which becomes of a light or orange coloured powder, 
being termed in the shops Sulphur Auratum Antimonii, or the Sul- 
phuretted Sub Hydro Sulphate of Antimony. These preparations 
coincide nearly in their action upon the human system, except that 
the former containing less sulphur, mnst be given in smaller doses 
than the other. These medicines are little known in England and 
this country, but in France and other parts of the continent of Europe 
they are much employed. 

Medical properties and uses of these Articles. 
Given in small doses they exert a considerable influence on the 
coats of the Stomach, producing nausea, and promoting considerably 
the secretions of the skm and lungs. 

The action is often extended to the Alimentary Canal, and a pur- 
gative operation frequently follows their employment. Hence at a 
proper period they are valuable in inflammatory affections of the lungs, 
in pneumonic complaints, and in catarrhs, either of an acute or chro- 
nic character. I have on several occasions had recourse to these ar- 
ticles, and can with confidence recommend them to you, as remedies 
upon which dependance is to be placed in diminishing morbid excite- 
ment, and by determining to the surface, allaying that irritation of 
the lungs which excites and provokes coughing. 

I have on several occasions relieved very distressing coughs by 
the use of this article, rubbed up with a solution of Gum Arabic, 3ss 
to 3ii. with a |vi. of the solution. The nausea it excites diminishes 
action, and determines to the surface, while the pulmonary secretion 
being augmented, expectoration is more easily performed. With its 
use other means are necessarily conjoined, as vena sect, before or dur- 
ing its employment, evacuants generally, regimen, and confinement 
to bed, the surface kept warm. 

Treat all Pulmonary affections, even mild ones, as important, and 
you will less seldom err, from too much than from too little caution. 
Recollect that most diseases commence with irritation of function, 
and pass often rapidly into derangement of structure. 



XC1V. 

They are useful in Febrile affections, and may well be substituted 
for the Pulv. Antimonials, being not only more uniform in their ope- 
rarion but decidedly more energetic. The usual dose for the fulfil- 
ment of the above purposes, is from, ii. to iij. grains. 

In large doses as from vi. to x. grains, it operates as an Emetic. 
These are the principal preparations with the Alkalies. 

4. By the action of Nitre on Antimony we obtain the Crocus An- 
timonii, and the Calx Nitrata. The former is so violent in its opera- 
tion, that it is wholly rejected in the practice of Physic, and the 
latter is superseded by the more valuable article the Pulvis Antimo- 
nialis. 

Preparation of the Pulvis Antimonialis. 

It is prepared by exposing the Sulphuret of Antimony and harts- 
horn shavings to a white heat for a certain time. The animal mat- 
ter, and the Sulphur of the Antimony are driven off, leaving an oxyd 
of Antimony, with Phosphate of Lime, which combined together 
form the Antimonial powder of the shops, or the oxide of Antimony 
with the Phosphate of Lime. 

These are the principal preparations from the Sulphuret of Anti- 
mony. 

With the oxydes of Antimony united with acids, so as to form 
salts, there have been many preparations in use, — but few are employ- 
ed at the present time, The most important is the Emetic Tartar, a 
compound of oxyd of Antimony, Tartaric acid and Potash. 

Antimonium Tartarizatum. — Is the most valuable of all the pre- 
parations of Antimony. Its chemical history is involved in some 
doubt, and is still unsettled. It is stated in the various dispensatories 
to be a triple salt, consisting of Tartaric acid, oxide of Antimony, 
and Potash, and which therefore ought to be termed a Tartrate of 
Antimony and Potash. It is obtained by boiling Bitartrate of Potash 
with protoxide of Antimony, in a glass vessel for a quarter of a hour, 
and setting the liquor by to cool. In this process the excess of Tar- 
taric acid in the Bitartrate, is saturated by the Protoxide of Antimo- 
ny, and by evaporation and crystalization a triple salt, Tartrate of 
Antimony and Potash, is procured. It is of a white colour and a 
taste slightly styptic and metallic; It is sufficiently soluble in simple 
menstrua, and as it is almost entirely insipid and the requisite dose is 
in almost all cases comparatively small, it may be given (to children) 
where it would be difficult if not impossible to get down any other 
medicine. 

As an Emetic it is distinguished by the promptness, energy, and 
certainty of its operation. It excites the Stomach into forcible and 
long continued efforts to discharge the whole of its contents, and by 
its action being extended to the duodenum, its contents are thrown 
into the Stomach, and large evacuations follow its employment. The 
operation of Antimony is also extended to the Alimentary Canal, and 
hence it often proves considerably purgative, this effect taking place 
either when the dose has been greater than necessary, merely to pro- 



xcv. 

duce vomiting, or when the Stomach has escaped the action of this 
powerful medicine. Antimony appears to promote almost all the ex- 
cretions, and to quicken and stimulate the action of the absorbent 
vessels. From its operation upon these several parts of the system, it 
is preferred to all other Emetics, doing more to break up the morbid 
associations which are formed in diseases, to relieve the Stomach of 
its offensive contents, and to effect a solution of fever, than any other 
article with which I am acquainted. It is therefore at times adapted 
to the commencement of the continued fevers of our climate, in which 
when liberally and properly administered it does much to bring the 
disease to a crisis at the onset. v 

In Intermittent, Remittent, and continued Fevers this medicine is 
therefore properly resorted to in the early stages. The first object of 
the practitioner is to arrest the febrile action if possible, in its very 
commencement. This is accomplished by the use of such remedies 
as have the power of exciting a considerable shock or commotion in 
the system. One of the most efficacious of these means, when they 
can be employed, is the use of Emetics, which possess this great ad- 
vantage, that they may be employed at any period of the paroxysm. 
If an active Emetic, (the best I consider is the Tart. Antimony in 
combination with Ipecacuanha,) be employed during the continuance 
of the chills and free vomiting is excited, the cold fit is often speedily 
terminated and a general glow accompanied with a degree of perspi- 
ration is produced. If the Emetic is delayed until the hot fit has 
commenced, its operation is frequently followed by a free perspiration, 
as well as relief to all the concomitant symptoms, and the fever, es- 
pecially if aided by other means, is frequently interrupted in its pro- 
gress. Should it fail in bringing about a crisis of the fever, the Anti- 
monial preparations may still be continued during its progress in very 
minute doses. Whether they should be carried to the degree of pro- 
ducing nausea, has been a subject of controversy among very distin- 
guished physicians. With Dr. Cullen, Emetic Tartars as a favorite 
medicine in fevers, and he always recommends it, when speaking of 
it, in nauseating doses. By Drs. Fordyce, Balfour, and others, this 
practice has been condemned, and it is maintained by these gentlemen, 
that it produces the most decided advantages, when it produces the 
least sensible effects upon the Stomach. Nausea is so unpleasant a 
feeling, that few patients will be found to submit to a repetition of the 
medicine which is sure to produce it, and if from the experience of 
these gentlemen, the Tart. Antimony is found to operate beneficially, 
without the actions of the Stomach being disturbed or nausea pro- 
duced, it will be removing one of the most considerable objections to- 
wards its employment. 

Did the sickened state of the patient, Dr. Chapman observes in his 
Therapentics, operate in the beneficial way contended for, then the 
utility of the medicine should be proportioned to the effect thus crea- 
ted, and a variety of other nauseants, infinitely more powerful and 
lasting in their impressions, as the Digitalis, Tobacco, and Squills 



XCV1. 

ought to be preferred. But this is contradicted by experience, 
and Tart., Antimony, will be found beneficial in proportion to the im- 
pression which it makes. This impression would seem to depend 
upon the power of the medicine in moderating the action of the 
heart and arteries, and upon the exercise of this power its good effects 
seem to depend. To such a degree is it exercised that Dr. Balfour 
has not hesitated to attribute to it a sedative and febrifuge action 
and this independent of the production of nausea. 

Upon the principle of moderating the action of the heart and ar- 
teries, the Tart. Antimony, has been applied to other diseases, and 
especially the Phlegmasia^. In Pneumonia, after depleting measures 
have been carried as far as the strength of the patient will admit, 
without subduing the disease, this medicine given in small doses so 
as not to excite nausea, or discontinued when it does, will be found 
efficacious in relieving pain, increasing the freedom of respiration, ex- 
citing perspiration, and subduing the remaining inflammatory symp- 
toms, more effectually, and without further expenditure of the vital 
powers, than venre sect., or the usual depleting measures. In these 
cases I have employed it with the utmost advantage, given in small 
doses frequently repeated, under the circumstances I have specified, 
and always with the happiest effects. 

In Catarrhs, Chronic Coughs, employed at a proper period, there is 
no article which exercises a more salutary influence. By it an im- 
pression is exerted upon the disease infinitely to be preferred to that 
produced by mucilaginous drinks, cough mixtures, anodynes, &c. 
which are so often resorted to, and which are frequently so unavailing. 
These remedies allay present -suffering, while the morbid action still 
progresses. The Tart. Antimony strikes at the root of the evil. 

In Phthisis Pulmonalis administered in the same manner, advan- 
tage is often derived, and I have known the cough allayed, sleep in- 
duced, and the distresses of the patient quieted when anodynes disa- 
greed or failed in their effects. 

The same practice is useful in Rheumatism, either chronic or acute, 
in cynanche tonsillaris, in hernia humoralis, in ophthalmia, in chronic 
hepatitis, and a variety of other inflammatory affections. The strength 
of the mixture to be employed is half a grain or less to the ounce of 
water, or two grains to f vi. of water, and a tablespoonful taken every 
two hours, or at longer intervals, according to circumstances. In 
none of these cases is it intended that the employment of the Tart. 
Antimony should set aside the usual depleting remedies, in the early 
stages of the disease, but when they have been carried to a sufficient 
extent, the administration of small doses of this article will be found 
very advantageous. 

Such is the practice which is usually pursued in the employment 
of this article. 

Within a few years an entirely new course has been recommended 
in its administration. Rasori, an Italian, and the founder of the 
new Italian system of medicine called the counter stimulant, has 



XCV11. 

given it in very large doses in diseases. It is necessary I should par- 
ticularize the doses ; the quantity would never be conceived of by you, 
He employed it to the extent of 20 grains to 3L in the twenty-four 
hours, without exciting repeated vomiting or excessive evacuations, 
as one would think probable, but on the contrary with the happiest 
effects. Under this free administration of the article, the Stomach 
and Intestinal Canal are affected as by its ordinary use, with vomit- 
ing and purging, the pulse softens in a remarkable manner, it becomes 
less frequent and less forcible, the cutaneous secretion is abundantly 
increased, insomuch that the skin is constantly moist and even wet, 
and inflammatory action in the lungs or other internal organ by this 
revulsive operation upon the surface, is speedily removed. 

The same practice is pursued in inflammatory rheumatism, drop- 
sies, &c. In some instances relief was obtained by the evacuatfons 
(when first used) from the stomach and bowels, and afterwards by the 
pores of the skin. In other instances, though large quantities had 
been taken, no evacuations followed, and under these circumstances, 
the good effects resulting, have been attributed to the impression 
which this medicine makes upon the system, allaying irritation, and 
lessening the excited action of the heart and arteries. 

Lastly the Tart. Antimony has been much resorted to in the chro- 
nic affections of the skin and superficial ulcerations. Desault recom- 
mends it to be given in small doses so as to affect the bowels, though 
to produce any decisive effects, it must be long and perseveringly em- 
ployed. In Herpes, Lepra, it may also be found useful. It is given 
alone in minute doses, or combined with some other article which has 
a determination to the surface, as guaiacum or sarsaparilla. 

Applied -to the surface of the body, Tart. Antimony exerts an 
action which is somewhat specific. This consists in the production 
of a vesiculo-pustular eruption upon the skin, resembling in some 
degree the variolous, the pustules upon breaking discharging a good 
deal of matter, and a small ulcer succeeds which is slow in healing — 
the sensation produced in the part by the appearance of the pustules 
being compared to the continued presence of caustic. Thus a pow- 
erful and permanent stimulant action is excited, which has been taken 
advantage of in curing formidable and deep-seated affections. The 
efficacy of this application has been considered by the late Dr. Jen- 
ner in a dissertation on the influence of pustular eruptions in certain 
diseases incidental to the human body. Many obstinate chronic 
cases are detailed by him as cured by an application of the Tart. 
Emetic in the form of ointment. The diseases in which it was most 
successfully used were Mania, Hypochondriasis, Pulmonary affections, 
Rheumatism, Hooping-cough, &c. In these cases, the ointment is 
rubbed over the diseased parts, or as near to the seat of the disease as 
is possible. 

In Rheumatism especially, the application has been much employ- 
ed, and it has been said to be a remedy of great efficacy. In recent 
cases the first or second application has often removed the complaint, 
13 



XCV111. 

but in those which occur, by far the most frequent are of long stand- 
ing, in which it may often be necessary to persevere in the frictions for 
three or four weeks. Upon the eruption making its appearance it 
must be discontinued until the soreness is removed, when it may 
again be applied, with the effect of renewing the crop of pustules, 
and so on until a cure is effected. 

In Phthisis Pulmonalis the application is made to the chest, and 
in Mania to the scalp. The connection between cutaneous eruptions 
and internal diseases has not escaped the observation of many physi- 
cians, and I may even add the notice of unprofessional persons. 
Epilepsy, Mania, Delirium in Fever, Phthisis Pulmonalis, &c. have all 
been observed to be removed or excited by the recurrence or recession 
of cutaneous eruptions. The consent between the skin and lungs is 
particularly manifested in the effects of repelled itch, small-pox or 
measles, which seem to fall immediately upon the breast. — Huxham. 

It is then from analogy, that the practice of exciting artificial cu- 
taneous eruptions, in any of the above diseases is established, and the 
testimony of Jenner, a name which can only be uttered with rever- 
ence and gratitude, is strongly in support of its utility. Thus have 
we opened a wide field for observation, and the application of our 
remedies, — if any interest has been excited in the remarks which 
have' been made, it will be renewed with infinite pleasure and profit, 
by reading the very valuable paper of Dr. J. on the subject. 

The ointment is directed to be made of the following strength, viz. 
Tartarized Antimony, ^i.. Lard, fi., to be well mixed. This is to be 
applied by friction in. the neighborhood of the part affected, and to 
the inside of the arms. The friction is continued once or twice a 
day, for two, three or four days, according to the sensibility of the 
skin, when a crop of pustules takes place, and in many cases with 
great relief to the symptoms. The reason of the greater relief af- 
forded by Tart. Antimony than by Cantharides is, that it not only 
vesicates, but it produces diseased action of the skin itself, by deep- 
ly deranging its structure, and in the ulceration extending beneath its 
surface. 

Of the forms in which the Emetic Tartar, is exhibited. — It is 
readily dissolved in cold water, but more so in warm. The dose as an 
Emetic is from ij. to v. grains, and it is best given in divided doses, 
(as some persons are more readily affected by it than others,) at inter- 
vals of 10 or 15 minutes, until vomiting is excited. 

Another form in which this medicine is employed, is dissolved in 
wine, constituting the well known preparation, the Antimonial wine 
of the Dispensatories. This was formerly made by dissolving the 
glass of Antimony in wine, but it was often found to be uncertain in 
its operation, the strength of the solution varying with the degree 
of acidity of the wine, its power being in proportion to the oxide 
which the tartaric acid of the wine dissolved. It is now prepared by 
dissolving 3ii. of Emetic Tartar in ^ii. of warm water, and adding to 
this f viii. of white wine. An ounce of the wine contains grains iv. 
of the Tartar and is a dose!. 



XC1X. 

In preparing the Antimonial wine a considerable portion of inso- 
luble matter is frequently observed in the bottom of the vessel, which 
upon examination proves to be Super Tartrate of Potash and Tar- 
trate of Lime. These precipitates are more abundant in the powder 
of Emetic Tartar, hence its greater cheapness than that purchased in 
the crystallized form. 

The Antimonial wine is a favorite preparation. It is often given to 
children, and is prescribed occasionally at a very early period of their 
existence, though in most cases I should prefer the Ipecacuanha. 
As it may sometimes be necessary, the following are the doses in 
which it should be administered. To infants at the birth, when it 
is given to relieve difficult respiration, the dose should not exceed one 
or two drops. At any period during the year, provided they have 
attained the age of three or four months, the dose for the purpose of 
vomiting is 10 or 15 drops, to be repeated at short intervals, according 
to the urgency of the case. In our employment of the Antimonials 
in the diseases of children, we cannot be too cautious, as I have 
known the 32-100 part of a grain given to a child within the week 
to operate very powerfully. 

Tart. Antimony used in the form of Enema, has been recommended 
by several physicians as a powerful remedy, and said to be applicable 
to a great diversity of cases. 

From the relaxation produced by the action of this medicine upon 
the muscular fibres, not only of the bowels, but the whole system — 
injections with this article have been recommended in obstinate ob- 
structed bowels, in bilious colics, and in othor spasmodic diseases. 
In these cases, 8 or 10 grains of the Emetic Tartar dissolved in water 
may be used as an Enema, and it will in most cases succeed very 
well. If it does not, we have only to increase the quantity and re- 
peat it in 30 minutes. I have never had occasion to make trial of 
this injection, but it is recommended by several physicians. By Dr. 
Chapman its use has been suggested in Tetanus, and for his reason- 
ing upon the subject I will refer you to his Therapeutics. 

Taken in an over dose into the Stomach, it excites the most alarm- 
ing symptoms — they are incessant vomiting, cramps and pain in the 
Stomach, muscular contraction of the limbs, cold sweats, great pros- 
tration, &c. The remedies which should be employed in this state 
of the system, are flannels wrung out of hot vinegar, or spirits, to 
the epigastrium. If this does not succeed, laudanum must be resorted 
to — at first in moderate doses, repeated every 10 minutes, which may 
be increased to ji, or more, for it should be observed that pain modifies 
the operation of Narcotics upon the nervous system, so that krge 
doses may be exhibited without any unpleasant consequences — cat- 
aplasms of mustard should be applied to the epigastrium, and if ne- 
cessary to the extremities, the warm bath. In this irritable state of 
the Stomach, the drinks taken should be small in quantity, as any 
degree of distension produced by them will certainly renew the con- 
tractions of this organ and the expulsion of the article taken. To 



c. 

these may be added the infusions, and decoctions of bitter and astrin- 
gent vegetables. For instance, it has been observed that fi. of the 
decoction of yellow bark is capable of completely decomposing 3i. of 
this salt, and of rendering it inert. Accordingly, its immediate exhi- 
bition has been recommended, when an over dose of this salt has been 
taken. An Infusion of Galls will have the same effect, and rhubarb 
is also an incompatible substance. The operation of these articles in 
decomposing the Antimonial salt is the following. All the substances 
possessed of astringent properties, contain gallic acid. This acid 
unites itself to the oxyde of Antimony, and forms with it a new 
compound, which has no Emetic properties ; — Gallate of Antimony. 

I have thus concluded what was necessary to be said on the em- 
ployment of the Tart. Antimony. It is a preparation particularly 
valuable, and deserving your attention, and I cannot but consider it 
one of the most fortunate discoveries which Chemistry has added to 
the Materia Medica. It is unquestionably one of the most active and 
efficacious medicines which we possess, and were I to sum up its 
powers in a few words, I would say it was ipse agmen, a host within 
itself. 



Sulphas Cupri — Sulphate of Copper. — In continuation of the sub- 
ject of Emetics, I shall speak of some other mineral preparations. 
Copper affords us several very powerful Emetics, but the only one in 
use is the Sulphate of Copper. It is obtained by evaporating waters 
which hold it in solution. Such waters are to be found in Copper 
Mines, where the Sulphuret of Copper, by exposure to air and mois- 
ture is converted into Sulphate. Sometimes it is produced artificially, 
by calcining the native Sulphuret of Copper, and exposing it in a hu- 
mid state to the air, the metal becomes oxidated, and the sulphur ab- 
sorbing oxygen is converted into Sulphuric acid, and the Sulphate of 
Copper is formed. This is then dissolved and crystallized. 

Copper in its metallic state exerts but little action upon the system. 
A remarkable case in illustration of this fact is related (by Dr. Paris) 
of a young woman, who swallowed six copper pieces, with a view of 
destroying herself. She was attended for two years, by several phy- 
sicians, for a disease which was considered visceral, but it was the 
effect of the mechanical obstruction occasioned by the coin. After 
some years had elapsed she voided them, and then confessed the 
cause of her protracted disease, during the whole of which no symp- 
tom arose which could in any way be attributed to the poisonous in- 
fluence of Copper. When poisoning occurs from Copper, it pro- 
ceeds from the want of cleanliness in the use of Copper vessels, by 
which they are suffered to become coated with the green carbonate, 
but more frequently it happens from vinegar being allowed to stand 
in such vessels until verdigris is formed. 

Sulphate of Copper is distinguished by the promptness and activity 
of its operation. In a large dose it has succeeded in expelling Nar- 
cotic substances, after other Emetics, particularly the Sulphate of Zinc, 



• CI. 

had been used without effect. In these cases where the irritability of 
the Stomach has been greatly impaired, and the patient nearly m a 
state of insensibility, it has produced instantaneous vomiting, when 
given to the extent of 10 or 15 grains, dissolved in water. As it is 
sometimes very violent in its operation, even in small doses, it is not 
much employed in general practice. It may be beneficially employed 
in certain cases. 

In Cynanche Trachealis it has been extolled as being more decided- 
ly efficient and speedy in its operation than any othei Emetic. From 
the insensibility which exists in the Stomach to impressions in some 
of the stages of this disease, I should suppose it a remedy well adapted 
to these cases, and that it may with great propriety be resorted to, 
after milder means have failed of producing Emesis. By a German 
practioner* it has been recommended as an excellent remedy in this 
disease, especially after V. S. In slight cases he begins with giving 
from a quarter to half a grain every two hours. In those (jases, how- 
ever, where there is much stridulous breathing, denoting inflammation 
of the larynx or bronchia, 3, 4 or more grains are administered, to ex- 
cite vomiting. By so doing the lymph is not only expelled from the 
trachea, but also the further secretion of it is prevented, so that the 
patient is much relieved, aud even cured. After copious vomiting has 
been produced, the medicine is to be given in small doses in conjunc- 
tion with Digitalis. In support of the utility of this practice, it is 
affirmed that it has been employed with the greatest success, during 
a period of ten years, in, a great number of children affected with 
croup, without losing a single patient in that time, notwithstanding 
the disease was often at its height when first called. This is certain- 
ly speaking of the remedy in' very strong terms, and the practice pur- 
sued is worthy of your attention. Such is the relief afforded by fre- 
quent and free discharges from the Stomach, and such the power of 
Emetics in producing new determinations of the circulating fluids, 
that their value cannot be too highly appreciated. • 

Upon this article I need not dwell very long, it does not exert any 
very considerable curative operation, neither do I know of its being 
applied to any cases in which the Tart. Antimony or other prepara- 
tions may not be used with infinitely more advantage. Some physi- 
cians are partial to it as an evacuant of the Stomach, and as it is 
conveniently administered in the form of pill for this purpose, it might 
on some occasions be found useful. 

Besides its Emetic properties the Sulphate of Copper may be so 
exhibited as to prove a valuable tonic. In minute doses as the quarter 
or eighth of a grain, it has been employed as a useful auxiliary to 
bark, in the management of obstinate and protracted Intermittents. 

As an Escharotic it is well known, a weak solution being employ- 
ed as a wash for indolent and foul ulcers. 

The dose of the Sulphate of Copper, as an Emetic, is from ij. to v grs. 

* Dr. Hoffman. 



Cll. ' 

Poisoning from the Salts of Copper. — This is not a very common 
occurrence, in consequence of the great care taken in the use of cop- 
per vessels, and the general knowledge which exists upon the cautions 
to be observed. They may, however, be taken either accidentally or 
by design. 

The symptoms excited are the same as those produced by arsenic, 
or corrosive sublimate ; — violent colic pains, vomiting, and purging, 
the eructation of a matter containing verdigris, sometimes salivation, a 
small pulse, and blueness about the eyes, jaundice, a copper taste in 
the mouth. 

Morbid Appearances. — Chiefly signs of Inflammation. The Sto- 
mach is of a green colour, its inner coat excessively inflamed. Ul- 
ceration, and the contents of the Stomach to be found in the sac of the 
peritoneum. 

Treatment — After experiments with various substances, Orfila has 
ascertained^ that the best is Albumen. 

Operation of Albumen on the Salts of Copper — Has the property 
of precipitating solutions of Coppery Salts, reducing them to the 
state of an oxyde, and of forming an insoluble compound with the 
oxyde. 

Sugar is recommended as superior to Albumen. 

The efficacy of Sugar in counteracting the poisonous effects of 
Copper is confirmed by the practice of Fishermen in the West Indies. 
At certain seasons in the spring and summer, the eating of certain 
kinds of fish is extremely dangerous, the symptoms produced being 
those of a very violent character, such as attend the most virulent 
poisons. Various causes have been assigned respecting this poison. 
The opinion entertained very generally is, that the sea impregnated 
with Copper renders the fish poisonous. To counteract the poison of 
the fish, the juice of the sugar cane has been found very effectual. 
So perfectly are the fishermen convinced of the fact, that they never 
hesitate toteat of the suspected fish, provided they can procure the 
juice of the sugar cane — they bruise the cane between two stones, 
and express the juice, which they immediately drink, without further 
preparation. — SigmonoVs Lectures. 

The operation of Sugar upon the Salts of Copper, is to reduce them 
to the state of a Protoxide. 



Sulphas Zinci — Sulphate of Zinc. — Zinc is another of the metals 
from which we obtain a valuable Emetic preparation. It is found in 
combination with different minerals, in various parts of the world, in 
England, Hungary, Germany, usually united with Sulphur, forming 
the ore called blende, which is a Sulphuret of Zinc. 

Sulphuret of Zinc found native, is of a dark or black colour, con- 
fusedly crystallized. It has some resemblance to the Sulphuret of 
Lead, but is distinguishable from it by several characters, particularly 
its less shining and metallic surface, and its greater hardness. In its 
metallic state it exerts no sensible action upon the system, and to be 



cm. 

rendered active it undergoes certain chemical changes, by which it 
acquires different degrees of activity. 

The preparation to which I shall call your attention is the Sulphate 
of Zinc. It may be prepared by the immediate union of its principles, 
by dissolving Zinc in Sulphuric Acid diluted with water. But most 
of the White Vitriol of commerce is obtained by exposure of the 
Sulphuret of Zinc to air and moisture. The metal thus become oxi- 
dized and the Sulphur acidified, and by mutual action a Sulphate of 
Zinc is formed. It is in the form of white masses grained like sugar, 
often spotted with yellow. It has a pretty strong acrid, styptic, me- 
tallic taste, and is soluble in twice its weight of water. In this state 
it is not a pure article, but contains Sulphate of Iron, and some- 
times Sulphate of Copper. The Sulphate of Zinc, is separated 
from these, by dissolving it in water, boiling it with the oxyd of Zinc, 
which precipitates the Iron and Copper — the solution is then evapora- 
ted and crystallized. 

This is the only Emetic preparation, and it is not commonly em- 
ployed in cases in which an Emetic is indicated, but it is especially 
had recourse to as it operates speedily and with much force, in cases 
where it is of importance that the contents of the Stomach should be 
immediately evacuated, as when poisons have been taken. The 
dose under such circumstances is from 20 to 40 grains, but in ordina- 
ry cases, 10 or 15 grains repeated until vomiting is excited are suffici- 
ent. Possessing no advantages over other Emetics, and being ex- 
tremely harsh and unpleasant to the taste, its use was limited to few 
diseases, until Dr. Moseley, a distinguished writer on the diseases of 
the West Indies, introduced it into notice. By him it was extolled 
as an Emetic, in the highest terms, and the language he employs is 
more that of an enthusiast than an experienced practical physician. 
As an Emetic, he saysgthat it is in all respects safe and innocent, pos- 
sessing advantages over all other nauseating and Emetic substances 
whatever, which are that the patient is not harassed with its opera- 
tion, for that it is never violent, generally instantaneous, and as sud- 
denly over, always leaving the Stomach invigorated. Neither, says 
he, does it produce spasms in the bowels, nor any nervous affection. 

It is the basis of the preparation known by the name of Moseley's 
Vitriolic Solution, and as'this is the form in which it is applied to dis- 
eases, the following is the mode of its preparation. 
R. Vitriol. Album, 3iii. ~| Let them be mixed in a mortar. The 
Sulphat. Alum., 3i. (cochineal is first to be rubbed fine, and the 
Cochineal, grains iij. [alum and vitriol are then to be added and tri- 
Water, Ibi. J turated. The water is to be poured on, and 

the whole set by to settle. 

In this solution the proportion of either the vitriol or the alum, 
may be augmented or diminished according to circumstances, that is, 
when evacuations are required, the quantity of alum may be dimin- 
ished, or even entirely omitted, — and when great astringency is re- 
quired the quantity of alum is to be increased and the vitriol to be 



civ. 

diminished. The dose is from a tablespoonful to a teaspoonful, ac- 
cording to the age and strength of the patient, which is to be taken 
every morning, fasting, in some cases to be repeated every six hours. 
The solution is very unpleasant to the taste, but it cannot be improved 
in this respect, at least without impairing its virtues. 

The vitriolic solution has been applied by Dr. Moseley to several 
forms of Intestinal disease. In Dysenteries, Diarrhoeas of long stand- 
ing, in Colica Pictonum. In Pulmonic affections, when respiration is 
performed with difficulty, and when expectoration is to be promoted, 
as in catarrhal coughs and hooping cough, in Phthisis Pulmonalis, 
it has been recommended in' the highest terms. 

, The Vitriolic Solution to the best of my knowledge is not much 
employed in this country, and I do not recollect having ever used it. 
The diseases in which it has been employed, having been found to 
yield in most cases, to other forms of practice. I wish not, how- 
ever, to say any thing which may discourage you hereafter from 
making trials with it yourselves. Fashion, be assured, exercises its 
influence even in our department, and because an article is not in 
vogue its merits are overlooked. Such, however, is the diversity of 
organization, temperament, and condition of the human frame, that 
a variety of remedies is often called for; what has succeeded in one 
case has no effect in another. You should therefore be made ac- 
quainted with the diversities of practice suited to the same disease, 
hereafter convenience, necessity, and more particularly the patho- 
logy of the complaint, may direct your choice. Operating as this 
medicine commonly does, as a mild nauseative and Emetic prepar- 
ation, it may be considered well suited by these effects to the man- 
agement of the several diseases I have mentioned. For further par- 
ticulars, in the employment of the Solution, I refer you to the work of 
Dr. Moseley, on the Diseases of Tropical Climates. 

The Sulphat of Zinc, has been recommended in cases of Angina 
Pectoris. In this disease when the peculiar and characteristic symp- 
toms have existed in a very strong degree, and after the usual reme- 
dies were unsuccessfully employed, recourse has been had to this 
medicine, and it is said with very good effects. It is given in small 
doses as a grain morning and evening, with a quarter of a grain at 
bed-time, increasing the quantity as the Stomach will bear it. The 
dose may be increased to two and a half grains, and several cases are 
related, as restored by this medicine. 

With ttie nature of this complaint, many of you are probably 
well acquainted. It consists in an organic derangement of the heart, 
either of its valves or arteries, or of some irritation of the cardiac 
nerves, giving rise to pain ; so that originating in such causes, it is not 
probable that a few grains of this substance will exercise much in- 
fluence on the disease, neither should it be depended upon. Other 
means more effectual should be kept in view, as blood-letting, diet, 
rest, counter-irritants, and it is only after they have been effectually 
tried, can any advantage be expected from the Sulphate of Zinc. 



cv. 

From the utility of Emetics in some diseases of the Thorax, this ar- 
ticle has been employed in Asthma, Pertussis, &c. Emetics are 
useful in these cases by retarding the approach of the paroxysm, 
promoting free expectoration, and producing a determination towards 
the surface. It is on this account that Ipecacuanha and Squills have 
stood foremost in the list of remedies for these diseases, a considerable 
time, and this undoubtedly from the good effects observed from their 
nauseating and Emetic operation. By some practitioners the Vitriol 
Alb. is preferred to these medicines, not only as it affords relief by its 
Emetic operation, but being also antispasmodic. 

A brief consideration of the Pathology of Asthma will render the 
benefits to be derived from Emetics more striking. The immediate 
cause of the distressing symptoms experienced, is attributed to a spas- 
modic affection of the bronchia, or a morbid thickening of the mucous 
membrane lining the bronchia, such as occurs in coryza, or cold in 
the head as it is termed, the nostrils being stopped up as it were, from 
the thickening of this membrane. The consequence of this state of 
the parts, is an obstruction to the free ingress and egress of air in res- 
piration. The air being obstructed in its free passage into and out of 
the lungs, expectoration cannot be performed, or only with difficulty. 
The mucus secreted by the bronchial passages being retained, adds 
much to the embarrassment of the breathing. 

The freedom of action in the lungs being interrupted, the blood 
circulates with difficulty, it is accumulated in the lungs, and adds to 
the existing distresses of the patient. The functions of the lungs are 
imperfectly performed, hence the lividness of the lips, face, and of the 
ends of the fingers, the coldness of the surface, &c. The point from 
which this train of evils proceeds is that state of the solids giving 
rise to the production of spasm. Emetics then by their impression 
upon the system and the production of nausea, favour relaxation of 
the muscular fibre, the air in the lungs being variously agitated, 
during the action of vomiting expectoration is promoted, and the 
fluids of the body by the diversion given them, are directed from the in- 
ternal to the external parts of the body. Thus the congestion of the 
lungs being relieved, their functions are better performed. Of the 
several Emetics which by occasioning vomiting, effect these salutary 
objects, the Vitriol Alb. has been recommended, since it has been 
supposed to exert in addition an antispasmodic operation. This 
opinion, though supported by Akenside, is not confirmed by practice, 
and in my employment of this article I have not experienced greater 
advantages from its use than from any other Emetic. 



14 



CV1. 

Division II. 
Medicines which Irritate the internal surface of the Alimentary 

Canal. 

CATHARTICS. 

This division of the Materia Medica is probably the most useful 
and important of any which will engage our attention. It is more 
extensively applicable to diseases, is resorted to on a greater variety 
of occasions, and is of very essential benefit in controuling and sub- 
duing the morbid operations of the system. On this account I will 
enter particularly into the consideration of the effects and operations 
of this class of medicines. 

To form a just idea of the operation of Cathartics, it will be neces- 
sary to consider with a little particularity the effects which follow 
their administration.* As soon as they are exhibited the appetite 
and all desire for nourishment is destroyed, nausea succeeds, an un- 
easiness is experienced in the Stomach, which is occasionally increas- 
ed to a considerable extent, with a sensation of heat and restlessness. 
As they proceed down the intestinal canal, the action of this organ is 
increased, a rumbling motion is frequently felt, and the abdomen has 
an uneasy sensation of distension. 

The pulse is small and irregular at this period, and other symptoms 
denoting a disturbed state of the system generally, as frequent he,ats 
and chills, the skin dry, with an increase of the animal temperature. 
These symptoms are relieved by the evacuations taking place, which 
are repeated in an indeterminate number of times, and which present 
considerable varieties in quality and quantity. 

The effects described will vary according to the nature and activity 
of the purgative employed, sometimes much distress is excited, and at 
others little is felt. 

In explanation of these effects it will be readily perceived that they 
have their origin in the action of the Cathartic upon the surface of 
the Intestinal Canal, and that most of the phenomena excited, are 
derived from the impression of these substances upon this surface. 
It will also be perceived that there are certain general symptoms pro- 
duced, which prove that this impression is extended to all parts of the 
system. Cathartics therefore exercise a local and a general action. 
I shall offer some remarks upon each, but before I proceed it may be 
useful to take a cursory view of the structure of the Alimentary Ca- 
nal, as it is from the consideration of its various functions that we 
are made particularly sensible of the benefits conferred by these 
medicines. 

The Internal surface of the Intestinal Canal is lined by a delicate 
membrane thickly studded with small follicles, which secrete a viscid 
mucus, and from this circumstance has been called Ja mucus mem- 
brane. To the Intestines there is sent a liberal supply of blood vessels 

* Vide Barbier, Traite Elementaire. 



cvn. 

which penetrate into their texture, and are distributed in an infinite 
number of minute ramifications. These vessels become very appa- 
rent upon any irritating substance being applied to them, they become 
red as if injected, and from them is poured out an abundant supply 
of serous fluids. To the fluids derived from these sources must be 
added those derived from the glands, as the liver, and pancreas, which 
have their ducts opening in the duodenum, along which irritating im- 
pressions are conveyed to their respective glands, giving to their secre- 
tory functions increased activity. 

Exterior to the mucus membrane there exists a muscular coat 
formed of circular and longitudinal fibres. It is this coat which oc- 
casions the vermicular motion with which the Intestines are animated. 
Excited by the action of Cathartics these fibres have their contrac- 
tions increased, the peristallic motions become quickened, and the con- 
tents of the bowels are urged on with some degree of rapidity to the 
rectum. 

That Cathartics operate by a local impression upon these parts, and 
that it is of an irritating nature hardly requires to be proved. It is 
however illustrated very fully when those of a drastic character have 
been exhibited. It is then shown that the action which is excited is 
of an inflammatory nature, the dejections become bloody, with dis- 
tressing griping pains, the abdomen is tender to the touch, and if the 
texture of the Canal is deranged death ensues. 

Orflla has proved that many natural productions, which are em- 
ployed as Cathartic medicines, are capable of inflaming the Intestines 
of animals to which they have been exhibited, and that they cause 
injuries similar to those of the more acknowledged poisons. The ir- 
ritation, however, which is necessary to excite a Cathartic operation 
is not of such intensity, and does not excite such distressing symp- 
toms. It is an irritation, moderate and gentle in its effects, and a ca- 
thartic agent is one endued with the faculty of exciting this particu- 
lar action. 

The effects therefore or the physiological phenomena which follow 
the administration of a Cathartic medicine, are an increase of all the 
vital energies of the Alimentary Canal. The capillary vessels 
which form a net work, become more apparent and distended with 
blood, and the serous exhalation which in a natural state moistens 
the interior of the Intestinal Canal, is excited to a more copious se- 
cretion. The mucus follicles which are spread over the surface be- 
come very active, and furnish in a short time a very abundant dis- 
charge. The action of the Purgative does not cease here, but the 
several ducts which terminate in the Duodenum have this action ex- 
tended to their organs and they are excited to pour out their fluids 
more freely. 

While these operations are progressing, the muscular fibres of the 
intestines are also stimulated, and the peristaltic motion increased 
by which their contents are quickly propelled and discharged. 

From this view of the operation of Cathartic medicines it must 



CV111. 

be obvious how important is the subject upon which we are engaged 
and how extensive in its application to diseases. In diseases where 
plethora is to be removed, and the preternaturally increased action of 
the vascular system diminished, Cathartics next to vense sect, may 
be considered as the most prompt and powerful means we can employ. 

They are valuable in another point of view. 

By their stimulant action exerted upon the several parts I have 
mentioned, they not only are evacuants, but they act powerfully in 
equalizing the circulation. The essential principle of disease is un- 
equal excitement, and too great an accumulation of fluids in one part 
of the system, at the expense of another. Our duty is to rectify this 
state of the circulating system. Cathartics are, for this purpose, our 
best remedies, inasmuch as by evacuating one set of vessels, an afflux 
of fluids is determined to these parts, and relief is afforded to other 
parts of the system. Hence their utility in diseases of the head, the 
determination of the fluids in the vessels of the abdomen, which sup- 
ply the intestines, being increased by purging, the quantity and im- 
petus of the blood, in the vessels of that part of the system are pro- 
portion ably diminished. 

The degree in which these effects are produced, are influenced by 
the nature of the article which we employ, hence this class has been 
divided into Eccoprotics, Drastics, and Hyper-cathartics. This* divi- 
sion I consider objectionable, because the too last are converted into 
each other by an increase or diminution of the dose. 

The simplest arrangements is into Laxatives and Purgatives. 

By Laxatives is meant such substances as operate mildly without 
exciting any general affection of the system, without stimulating in 
any great degree the vessels of the Intestines, and hence they merely 
evacuate the contents of the canal. 

Purgatives are more stimulating, they occasion an influx of fluids 
from the exhalent vessels, and from the neighboring secretory organs, 
they even extend their stimulating effect to the system in general, and 
if taken in too large a dose excite much irritation, and even inflamma- 
tion upon the surface of the Intestines. 

In both of these divisions, the articles which produce these effects 
may be considered as substances which resist the digestive process, or 
whose nature the gastric juice cannot change, which irritate the sur- 
face of the Intestines, and afford nothing to be acted upon ; they be- 
come therefore medicines by compelling the bowels to revolt, if I may 
so say, upon what they cannot overcome. 

Besides these differences which arise from different degrees of ac- 
tivity, Cathartics will present other varieties in their modes of opera- 
tion, according to the part of the Alimentary Canal upon which their 
action is directed. This difference will probably be connected with 
the nature of the article itself, and will depend upon the peculiarity 
of its stimulus, or the readiness with which it undergoes solution in 
the bowels. Dr. Paris has so well expressed the idea I wish to con- 
vey, that I shall avail myself of his language. It is easy to conceive 



C1X. 

that a medicine may act more immediately and specially upon the 
Stomach, small or large intestines, according to the relative facility 
with which its principles of activity enter into solution. That those 
which are dissolved before they pass the Pylorus, are quick and vio- 
lent in their effects, and liable to affect the Stomach, as gamboge, 
while some resinous purgatives on the other hand, as they contain 
principles less soluble, seldom act until they have passed out of the 
Stomach, and often not until they have reached the colon; while 
others still less soluble have their action upon the rectum. These 
views will be best illustrated by examples of medicines, which have 
an influence upon different parts of the Intestinal Canal. 

Calomel for instance operates upon the upper portion of the Intes- 
tinal Canal, as exhibited in the biliary evacuatious which follow its 
use. Gamboge when given alone, on account of its ready solubility, 
has its action upon the same portion of the Canal, hence it sometimes, 
as well as Calomel, exerts an Emetic operation. Jalap and many 
other Cathartics have an action upon the small as well as large In- 
testines, and aloes and hellebore pass through them, and have their 
action principally upon the colon and rectum. This want of action, 
would seem to be connected with the slowness with which it under- 
goes solution. In short those substances we have called Emetics, 
seem also to owe the peculiar effects which follow their use in having 
their operation upon a portion of the Alimentary Canal still higher, 
viz. the Stomach. 

Cathartics differing in the degree of their action or irritation, as 
well as the parts of the Intestinal Canal upon which they operate, it 
follows of course that the evacuations produced by their use will be 
different. Some will simply remove the contents of the bowels, others 
will produce an increased discharge of bile, while others by stimulating 
the exhalents particularly, will produce an increased secretion from 
these vessels, and a discharge of watery passages. 

The qualities of the evacuations being different according to the 
purgative employed, it becomes necessary to give some explanation of 
certain terms which have been much employed in Therapeutics. 

From a consideration of the different qualities of the evacuations, 
the ancients applied to particular articles specific powers, and hence 
employed certain expressions to designate them, these were Hydro- 
gogues, Cholagogues, Phlegmagogues, &c, or medicines capable of 
causing a discharge of water, bile, phlegm. The idea which was 
attached to the term Hydrogogues, was not such as I have explained, 
as medicines which had the power of augmenting the exhalation of 
the Intestines, but they were considered as remedies which had the 
faculty of removing by a special virtue, a morbid serum which exist- 
ed in the system of the sick, and which was to be expelled downwards. 
The Cholagogues they conceived searched out in the body of the 
patient, bile which was depraved, which had fixed itself upon organs 
essential to life, which caused pains, and which supported the fever. 
These evacuants expelled the humor, and health was restored. The 



ex. 

Phlegmagogues carried back to the secretories of the Intestines a 
pituitous matter which had been thrown upon the lungs, head, &c. 

These terms originating in erroneous views of pathology, and the 
operations of medicines, are yet supported by actual appearances. 
All that we would understand by them however, is, that certain pur- 
gative substances have a tendency to act more upon one part of the 
Intestinal Canal than upon another, and in consequence of this deter- 
mination the appearance of the evacuations are different. Upon what 
this peculiarity in the action of Cathartics depends, our experience is 
not sufficiently extended to determine. 

My remarks have hitherto been confined to the action of Cathartics 
upon the surface of the Intestinal Canal, and the consequences which 
result from their irritation. 

I now proceed to consider the effects of their operation upon the 
system generally, 

An attentive consideration of what passes in the system, while under 
the operation of a Cathartic, exhibits important changes upon parts 
distant from the Alimentary Canal. 

These general effects may depend upon the particles of the purga- 
tive substance being absorbed and carried into the circulation, but it is 
principally to the connection which the surface of the Intestinal Ca- 
nal maintains with other parts of the system. 

It is known that Cathartics have a considerable influence upon the 
pulse. The pulse during and after the operation of a Cathartic is 
smaller and more frequent than in health, and when spasmodic pains 
arise commonly denominated Cramps, it, also becomes unequal and in- 
termittent. 

The secretions are materially deranged while some, those at least 
emptying into the Intestinal Canal are increased, others as the urine 
and perspiration are diminished. 

The animal functions experience a like disturbance — muscular 
motion is impaired — the sensations appear vague and imperfect — the 
intellectual functions are slow and difficult — the inclination to sleep 
is irresistible. We ought to attribute to irritation of the Intestines, 
many of these symptoms, to regard the thirst as resulting from the 
intestinal excitement of the purgative, the cramps as the effect of the 
impression made upon the nerves of the Intestines, and extended to 
those of the legs — the feebleness of the function of perspiration as 
resulting from a diversion of the cutaneous excitement, and an increase 
of that of the prima via. The Sleep which attends purgation often 
appears itself caused by the increased determination which takes 
place to the digestive system, resembling that which accompanies the 
process of digestion. 

The degree in which these effects will be experienced, will be in- 
fluenced by the character of the article employed. When of a dras- 
tic nature, all these effects will be experienced in the individual case, 
and the system will not only be slow in returning to the usual exer- 
cise of its healthy functions, but a degree of enteritis may be produced 



CXI. 

which will give rise in its turn to other and characteristic phenomena. 
When the article employed is of a mild nature, the system soon re- 
turns to the nominal exercise of its functions, — perspiration and urine 
are renewed, the pulse becomes more vigorous and strong, the desire 
for nourishment is restored. 

Such are the circumstances most worthy of consideration in treat- 
ing of the operation of this valuable class of medicines, and upon 
which we are led to reflect upon their utility, not only as depleting re- 
medies, but as exerting new changes in the system at large. 

Operating thus extensively they are highly useful in those states of 
the system attended with much excitement, but their employment has 
been objected to in diseases attended with debility. 

You have been informed that purgatives are depleting remedies, 
that they act by increasing the secretions of the bowels, and in their 
operation hurry off the chyle so as to preclude its entering the circu- 
lation. From these considerations they ought to be used with cau- 
tion in cases attended with much debility, but they ought not to be 
rejected altogether, because by their use the bowels are urged to expel 
their contents, by which their function^ are in some degree restored, 
the appetite and digestion are too often improved thereby, and the pa- 
tient so far from being weakened is placed in a condition to be nour- 
ished and strengthened. 

Cathartics have been objected to in diseases of some continuance, 
and in debilitated cases from another consideration. It has been said 
that as in such states but little food is taken, there can be little oc- 
casion for regular alvine discharges, neither ought they to be ex- 
pected. 

In all diseases, however, it should be observed, that some portion of 
nourishment is taken, which w ill contribute to the formation of fecu- 
lent matter. Yet in Fevers another supply is derived, not only from 
the abundant secretion of different organs, but from the excrementi- 
tious fluids which are poured into the Intestines. Under these cir- 
cumstances it is easy to perceive the importance of attending to the 
condition of the bowels, since independently of solid matter being 
taken into the Stomach, faeces are formed, which from the heat of the 
body, soon become acrid and irritating, and thus render the necessity 
of attending to the state of the primse vire extremely apparent. 

Before proceeding to the application of this class to diseases, I shall 
in a very condensed manner, speak of the general objects accom- 
plished by these medicines, as you will then be satisfied of their 
influence upon the animal economy, and of the great aid they afford 
in the practice of physic. 

1. In the first place they serve to evacuate the Intestines, and to 
carry out of the system the substances they contain. It is hardly 
necessary to point out the importance of this operation. In a state 
of health, its interruption deranges considerably the exercise of the 
digestive functions, occasioning pain in the head, oppression, general 
uneasiness, &c. In disease it is still more necessary that the first 



CX11. 

passages should not retain for any time, their faeculent contents, nor 
the excretions poured into them from various organs. For these sub- 
stances by being confined in the bowels loose their natural qualities, 
they excite much irritation, and give rise to various distressing af- 
fections. 

2. In the second place, the irritation which these medicines excite 
upon the internal surface of the Intestinal Canal, augments the se- 
cretory action of the liver, pancreas, mucus follicles, and at the same 
time a considerable discharge of serous fluid. From these several 
sources, the abdominal viscera are relieved from that turgescence of 
the vessels which has been called congestion, and the good effects of 
which are seen in a number of diseases. 

3. In the third place the vital forces are determined during their 
operation towards the abdomen, the blood circulates with more ac- 
tivity in these organs, there is more warmth, and more sensibility than 
under ordinary circumstances. 

The great afflux of fluids towards these parts, exercises a deriva- 
tive or revulsive action in regard to the head, the chest, and other 
parts of the body, and thus it is that a very salutary influence is fre- 
quently exercised. 

4. In the fourth place the strong impression made upon the nerves, 
expended upon the surface of the Intestinal Canal, is extended by 
means of the great sympathetic, to the brain, the spinal marrow, and 
by a necessary consequence to all parts of the body. It is to this ope- 
ration that we are to attribute very frequently the important results 
produced by these medicines — the actions often excited in remote 
parts — the alterations which take place in the secretions — the renewal 
of action — the change in short which the whole system undergoes. 

Lastly. The impression which these medicines make upon the 
organic tissues when their administration is not followed by alvine 
evacuations, but when their particles are absorbed ought also to be 
taken into consideration. 

These diversified operations entitle this class to be considered as 
Alterative medicines of great efficacy, and fully illustrate the very 
necessary aid they afford, in diseases of almost every description. 
Rules for the administration of Cathartics. 

A few rules upon the administration of Cathartics will close what 
I have to say upon their general operation. 

1 Cathartic medicines should be exhibited late at night or early 
in the morning, when circumstances are not very urgent. It would 
seem that during sleep the bowels are not so irritable, and consequent- 
ly not so easily acted upon, while by suspending the influence of the 
imagination it renders it less liable to be rejected. 

2. In cases of Fever, where it is necessary to consult the quiet and 
ease of the patient, it is important that the exhibition of Cathartic 
medicines should be so timed that their effects may be expected dur- 
ing the day. 

3. Cathartic medicines should be exhibited upon an empty Sto- 



CXUJ. 

much as we prevent their being rejected, and secure a more easy and 
effectual operation. 

4. To promote the action of these remedies, as well as to obviate 
griping, warm diluents are to be freely taken after the first discharges, 
as chicken water, gruel, tea, &c. 

Practical application of Cathartics. 

The application of this class of medicines is so general, that I can- 
not state a case of derangement of health, in which they may not be 
employed with some advantage. 

The Intestinal Canal is subject to so many irregularities of com- 
bination and action — its sympathies are so numerous and extensive — 
its functions so various and complicated, that the necessity frequently 
recurs of attending to its state and condition. It is, I may say, the 
sewer of the system, into which all the useless, foreign, and putre- 
scible materials are collected, into which the fluids of the body after 
having served their offices, and the excretions of the several glands, 
are emptied. 

From all these sources, it becomes engaged either in the production 
of disease, or instrumental in keeping up its activity. My time will 
only allow me to speak of the most important diseases in which 
they are used, and I can only dwell upon them in a cursory manner. 

In Fevers of every variety they are indicated. 

In these cases, they operate as evacuants and remove the remote 
causes, when they depend upon vitiated matter in the bowels. 

In Fevers the action of the bowels is always diminished, from 
which a state of fullness, restlessness, and anxiety is produced, 
which serve to aggravate the symptoms — Cathartics relieve this con- 
dition of the system, diminish and equalize arterial action, and stim- 
ulate the exhalents. They are useful in every stage of Fever — Given 
in the Incipient stage, they not unfrequently check its progress — dur- 
ing the course of the Fever they relieve symptoms, and so far from 
diminishing, often increase the strength of the patient. 

In Intermittents they are much used. In the early stage advantage 
is gained from Emetics, but Cathartics are also useful. 

In Remittents they are equally useful, and more frequently neces- 
sary. They are employed daily to evacuate the bilious matter, and 
to bring down the force of the arterial system. The secretions are 
in almost every case of Fever changed from a natural and healthy 
state, to a condition which renders them additional causes of irrita- 
tion to the already excited system. Cathartics therefore become ne- 
cessary and important throughout the whole course nearly of all 
acute diseases, for the purpose of removing these additional support- 
ers of Fevers. 

In our highly bilious grades of Fever, and in Yellow Fever, they 
are invaluable. 

To any one who considers the increased quantity and the vitiated 
quality of the Intestinal Secretions in these Fevers, the necessity of 
immediately discharging them will be sufficiently obvious ; and ac- 
15 



CX1V. 

cordingly most physicians are anxious to excite discharges from the 
bowels as soon as possible. 

These matters are often so acrid as to excoriate the rectum, and the 
skin immediately surrounding the part. Proofs are not wanting of 
this extreme acrimony in these cases, and instances must be familiar 
to most physicians. Dr. Physick's hand was inflamed by the acrid 
matter found in the gall bladder, and primae viae, in dissections made 
in the Yellow Fever of Philadelphia, in 1793. 

Not only in these Fevers is the utility of Cathartics established, but 
even in Typhus, or the weaker forms of Fever. 

To Dr. Hamilton, the Medical community is indebted for the im- 
portant advantages to be derived from regular alvine discharges in 
this disease. 

The presence of Typhus is marked by the following symptoms, 
(Hamilton,) viz. loss of appetite, thirst, sickness, white or loaded 
tongue, disagreeable taste of the mouth, and most commonly by con- 
stipation of the bowels. To these succeed languor, head-ache, debil- 
ity, and inaptitude for the usual mental and bodily exertions — morbid 
affections of the surface of the body, of the sanguiferous system, and 
of the different secretions soon succeed, to which in the advanced 
stage are added delirium, subsultus tendinum, and singultus. 

The treatment consisted in weak antimonials preceded by an Emetic 
and purgative in the commencment of the disease — but the condition 
of the bowels was little regarded in the after periods of the disease. 
The results of this treatment were extremely unsatisfactory, and 
upon having recourse to a stronger antimonial preparation, Dr. H. 
was soon convinced that its good effects were commensurate with its 
operation upon the bowels. The faeces were generally black and 
foetid, and in proportion as they were discharged the low delirium, . 
tremor, and subsultus tendinum which had prevailed, were abated, 
the tongue which had been dry and furred, became moister and cleaner, 
and the creeping pulse acquired a firmer beat. 

The practice now adopted is the rejection of Emetics and glysters 
in this Fever, while reliance is placed upon Purgative medicines for 
the purpose of ensuring regular alvine discharges. With this view 
Dr. H. prescribes active doses of medicine, and gives them every other 
day. Since adopting this practice we are assured that there is less 
need for stimulants in the treatment of this disease, and that it is 
much more manageable. The practice became general in England 
and even upon the continent — but in the United States the Typhus 
gravior and mitior of Cullen, rarely occurs, so that the efficacy of the 
practice recommended is seldom tested. 

The importance of the principle should still be kept in view, and 
even in the low forms of disease, the necessity of attending to the 
condition of the bowels should never be overlooked. 

In advocating the utility of Cathartics in Febrile diseases, it is 
proper to state to you, and even to admonish you, that in many in- 
stances they are abused or injudiciously employed. The remarks 



cxv. 

that I can make, must of necessity be very limited — practical views 
will be fully unfolded to you from another quarter — to me, alone, be- 
longs the Therapeutical applications of Medicines, and the cautions 
to be observed. 

I. Cathartic Medicines, then, are abused, or injudiciously employed 
when active or drastic articles are continued after the stercoraceous 
and acrid secretions of the bowels are discharged — Under these cir- 
cumstances, with the contents of the bowels, the mucus secretion, 
which lines and protects the tender surface of the internal membrane, 
has also been removed ; and the continuance of active articles can 
have no other effect than to wound and irritate this surface, to excite 
griping and distressing pains, followed by a frequent desire to evacuate 
the bowels — with small, thin, serous passages, attended with a pain- 
ful and distressing tenesmus. The stercoraceous and offensive secre- 
tions from the bowels being removed without subduing the disease — it 
will be proper to discontinue these medicines, and excite some other 
secretion into action. When further evacuations are required, it will 
be advisable to excite them by milder preparations, as they will most 
commonly be found better adapted to the condition of the vital powers, 
and fully capable of carrying off the secretions which have been 
poured into the Intestinal Canal. I could depict to you the bad ef- 
fects of a contrary practice, and have seen patients suffering under all 
the symptoms I have mentioned, the passages consisting of little else 
,than thin serous discharges, with flakes of mucus floating in the 
fluid. The continuance of these medicines, under these circumstan- 
ces, not only irritates the mucus surface to a considerable extent, but 
I will not go too far in stating, that instead of subduing, will be 
found to increase the Fever. You would hardly credit me were I to 
relate the extent to which I have known cathartic medicines pursued 
in febrile affections of an acute character. I have known from twenty 
to thirty evacuations excited from the bowels in twenty-four hours, 
not only from adults but in children. This practice is entirely wrong, 
it is absolutely destructive. You might almost question how such a 
number could be produced. The fact is undeniable, and it is adduced 
to show the pernicious extent to which these medicines are carried, 
and against which I warn you. These successive discharges are 
procured, not by two or three doses of active medicines, which are 
proper enough in the commencement of diseases, but by a continu- 
ance of the same medicine every two or three hours, for twenty-four, 
thirty-six, or forty-eight hours, and sometimes the whole course of 
the Fever. However excited, whether by Calomel alone, or its com- 
binations, whether Jalap and its combinations, or whether simply 
oleaginous articles, the practice is to be deprecated in the highest 
degree. I should be glad, if it were possible to give you definite rules 
on this subject. I can only state to you what has usually been my 

course. 

It is when called to a patient laboring under acute disease, to re- 
move as much as possible all apparent sources of irritation. If ne- 



CXV1. 

cessary, venisection is practised, if not, the condition of the Alimen- 
tary Canal, as affording many sources of irritation, a"nd having a 
more extensive influence upon the system than any other channel, is 
attended to. The stercoraceous and offensive contents of the bowels 
being removed, which is commonly done with half a dozen evacua- 
tions, with the continuance of the disease, I attempt the renewal of 
some other secretion — the skin, or urinary organs, and combat 
symptoms as they arise. When the condition of the bowels re- 
requires attention, which will be in twenty-four, or thirty-six, or forty- 
eight hours, to excite discharges by the same medicines, if it can be 
borne, and if not, by a milder article, always keeping the same ob- 
ject in view, a renewal of secretion, or a change of secretion, and 
combating symptoms as they arise. The resources of the Materia 
Medica are quite sufficient in by far the greater number of cases, if 
we only apply them properly, judiciously, cautiously. You will 
hear various and contradictory opinions as to the means by which 
this is to be accomplished — listen to them all and judge for your* 
selves. Having found a mixture of error and truth to exist in sys- 
tems and doctrines, I take advantage of the fact, judge for myself, 
and pursue an eclectic course. 

II. Drastic or irritating Cathartics are injudiciously, nay, impro- 
perly employed, in diseases attended with an inflammatory condition 
of the mucus membrane of the alimentary canal. When speaking 
of the physiological operation of these articles upon this surface, the 
remarks then made will render it unnecessary to enter into details— it 
is evident that they will exasperate all the symptoms. While on the 
contrary, from the milder articles, the most beneficial consequences 
must result. 

It seems to me, that in a subject of such importance, it might be 
advisable to particularize some examples in Febrile diseases in which 
the precautions I have mentioned should be observed, as well as the 
symptoms which lead to a knowledge of this inflammatory state. 

Without entering into the disputed question, whether Febrile dis- 
eases originate in an inflamed condition of the mucus membrane of 
the Alimentary Canal or not, I shall only observe to you, that Fe- 
brile diseases are often attended with a considerable determination to 
the abdominal viscera, and among the organs affected, the Stomach 
and Intestinal Canal frequently participate largely in these determi- 
nations. 

The symptoms which characterise this condition of these organs, 
are nausea, irritable stomach, vomiting of fluids taken, pain upon 
pressure, costiveness. When to these are added .redness of the 
tongue, either pervading the whole surface, or confined to the edges 
or tip, or when with this state, it is coated with a thick fur, — when 
thirst exists, and the pulse ranges from ninety to a hundred pulsations 
in the minute, we may be assured that abdominal inflammation exists, 
and under these circumstances, active medicines of an Emetic or Ca- 
thartic character, will be improper. Depletion by the lancet, should 



CXV1I. 

be preferred, until these symptoms are abated, fomentations to the ab- 
domen, warm cloths, and the mildest medicines employed — calomel, 
for instance, followed by castor oil — Evacuations from the bowels 
being effected by this course, the utmost relief will be afforded, and 
the patient will have reason to rejoice in the prudence, judgment, 
and discrimination of his physician. A contrary practice will but 
subject him to much and severe uneasiness and distress. 

Utility of Cathartics in Inflammatory Diseases. — The great utility 
of Cathartics is not only exhibited in removing offensive matters 
from the bowels, in depleting the chylopoietic viscera, and exciting a 
new and more healthy action, — but by the irritation they excite upon 
the serous vessels, and the mucus follicles, a copious secretion takes 
place from the extensive surface of the Alimentary Canal, and they 
become important remedies, as evacuants to the system generally. 
Hence their great importance in the treatment of Inflammatory dis- 
eases, and in the diversity of cases in which arterial excitement is to 
be moderated or reduced. 

In affections of the Lungs, as Pleurisy, and Peripneumony, the em- 
ployment of Cathartics has been condemned by some practitioners, 
apparently upon theoretical grounds — yet -it will be found that free 
evacuations from the bowels, conduce, like blood-letting, to diminish 
the general and local inflammatory action, and by a revulsive opera- 
tion to determine from these organs. 
• In inflammation of the Peritoneum and Intestines. 

The first object in these cases is to overcome the constipation with 
which such Inflammatory diseases is commonly so frequently at- 
tended. This object is accomplished by all the means resorted to to 
reduce inflammation — as venae sect., leeches, fomentations, evacuants 
by the bowels. The last by exciting secretions from the whole surface 
of the Intestinal Canal, are not the least important. We know that 
secretion is an ending of inflammation, and is frequently the sponta- 
neous mode of relief to the vessels of an inflamed part. The secre- 
tions excited by Cathartics are very considerable, furnished as they 
are from so many sources. If care therefore is observed in their ad- 
ministration, that is to say, if the stimulus of the article is adapted to 
the excitability of the part, very beneficial effects will follow. From 
inattention to this circumstance, the use of Cathartics has been ob- 
jected to in Enteritis, on the ground that they act as stimulants, and 
that stimuli applied to its seat must increase inflammation. The con- 
clusion against Cathartics on this ground is not legitimately inferred 
— for though their operation is stimulating, yet as they restore secre- 
tion, which is almost always diminished in inflammation, they are 
when employed at a proper period, and of a proper quality, agents 
to which we should have recourse, in order, as it were, to effect reso- 
lution. 

The constipation of Intestinal Inflammation is generally attended 
with vomiting, and almost every thing is rejected which is taken into 
the Stomach. It is common therefore to regard Cathartics as almost 



CXV11I. 

useless, to attempt the reduction of inflammation by bleedings, and 
afterwards to give Cathartics. This is practice that cannot be relied 
upon altogether — for though it is proper to bleed, and often freely, 
and use revulsives, yet we ought not to be satisfied until the bowels 
have been evacuated. It is true some perseverance is required, the 
medicine being often rejected as soon as taken, yet it is right still to 
persist, for although much will be thrown up, some will be retained. 
The quantity retained accumulates in proportion as it is repeated, and 
at last, with the aid of enemata, stools are produced, at first small in 
quantity, but afterwards more copious. With the accomplishment of 
this object the vomiting ceases, the tension of the abdomen is relieved, 
and the soreness diminished. This effect gained, it is seldom necessa- 
ry to resort to bleeding afterwards — the bowels, under the continued 
use of mild Cathartics, recover their disposition to healthy action. 

Although the constipation attendant on Intestinal inflammation is 
in general overcome by the above means, there are cases in which 
they have failed ; and the disease has in such appeared rapidly ap- 
proaching a fatal issue. Under these circumstances Calomel becomes 
a very important remedy, given in doses of 10 grains every 4 or 6 
hours, to the extent of producing salivation, and as soon as this has 
taken place copious stools have quickly followed, and a favorable 
convalescence has afterwards been maintained by Cathartics of a 
mild character. 

Of the utility of this class of medicines in Dysentery, you must 
have had opportunities of witnessing. There are few diseases less 
indebted to the natural efforts of the constitution for a cure, and in 
which the beneficial operations of this class of medicines are more 
conspicuous. The disease often has its origin in the irritating and 
vitiated nature of the contents of the bowels, and the first step is to 
remove these, by the employment of such purgatives as produce a 
full and speedy operation. As the secretions which are poured into 
them are perhaps in all cases in a vitiated state, purgatives must oc- 
casionally be employed throughout the whole disease. In resorting 
to this class of medicines, it is proper that the inflammatory condition 
of the mucus membrane lining the passages, be as little affected by 
the irritation of the process as possible. The irritation is sometimes 
so considerable that the patient conceives that his bowels are already 
too much griped and purged, and it might be supposed that any ad- 
dition from a purgative substance would be hurtful. This reason- 
ing is not correct, for by experience we are made acquainted, that 
by these means we remove a much greater irritation, the hardened 
excrements, and the morbid secretions, which actually cause and 
keep up the disease. 

In Diarrhoeas, Cathartics are also highly useful. This disease is 
frequently brought on by crude and undigested matter passing into 
the intestines, which by stimulating the excretions and the surface as 
they pass along, create a copious secretion of fluids, by which the 
constitution endeavors to rid itself of the irritation. Or it may be 



CX1X. 

produced by the morbid and acrid discharges of the liver and pancreas, 
and the multiplied combinations of chemical action, which are form- 
ed, when the digestive functions are not in a healthy state. . Cathar- 
tics become useful in removing the crudities which exist in the 
bowels, and the utility of the practice is confirmed by general expe- 
rience. 

In Colic, a disease arising from such a variety of causes, it is not to 
be supposed, that a single agent will be sufficient to contend against 
it. I have known it speedily removed by the use of an Emetic, and 
at other times the irritability of the Stomach has been such, that the 
mildest Cathartic could not be retained. This symptom must first be 
relieved, and for this purpose, V. S. the warm bath, opiates, adminis- 
tered internally, and by enemata, must be resorted to. As soon as 
Cathartics can be administered, they should be employed to such an 
extent as to produce free evacuations from the bowels, and it is only 
with the accomplishment of this object, that permanent relief will be 
afforded. The best combination in these cases is Calomel and Opium, 
given in large doses, and followed up as soon as practicable with the 
liberal use of the 01. Ricini. 

There are various other cases of Intestinal derangement in which 
the good effects of this class of medicines is exhibited, but I shall 
defer their consideration until speaking of the particular articles best 
adapted to them. 

Not only is this class of medicines of importance in the affections 
of the Alimentary Canal, but in those of the Chylopoietic viscera 
generally. Their use affords us the means of depleting from these 
organs, and by a continuance of the Oathartic according to circum- 
stances, we are able first to alter, and then subdue the derangements 
which exist. The cases to which I allude are those numerous exam- 
ples of deranged secretions, hepatic and intestinal, which though not 
reducible to classes and species, are frequently seen in practice. They 
are exhibited in the discharges of the patient, in a furred tongue, im- 
paired appetite, feverishness, irritability of temper, and deranged sensa- 
tions generally. In these cases, Cathartics are not to be used with the 
freedom which more acute cases require, — they are not to be employ- 
ed for their evacuant, but their alterative action, and by pursuing this 
course with steadiness, for weeks, and even months, the happiest ef- 
fects I have known to follow. It is in cases of this nature that the 
Blue Pill exhibits a very salutary operation. By its use, the action 
of the bowels has been kept up for weeks, and though there was 
commonly two or three evacuations daily, yet the patient without 
being debilitated, has been gradually relieved of the symptoms I have 
enumerated, and at the expiration of this period improved in health 
and appearance. It is probably from a similar action being kept up 
upon the bowels, that the mineral springs containing active purging 
ingredients as the Saratoga Waters, afford such relief to patients la- 
bouring under visceral affections, and this independent of the benefits 



GXX. 

which are attributable in all invalids to change of air, of scene, of diet, 
and the gaieties which these situations furnish. 

Cathartics in these cases excite an action which is different from 
the existing one, and to this circumstance we are to attribute many 
of their curative effects. They induce a new action in the secreting 
vessels, which though it does not destroy, yet it greatly weakens the 
existing disease, and they may properly be considered alteratives. 

Thus Rhubarb operates in curing Diarrheea, and thus Cathartics 
operate generally in the affections I am considering. 

In diseases of the Cerebal system, Cathartics are of the greatest 
service. Their good effects in these cases depend upon their opera- 
ing in three several ways. 

1. Evacuating the blood-vessels. 

2. Exciting irritation in parts distant from the affected. 

3. Inducing a new action. 

In Mania this class of remedies has been applied. The accession 
of this disease is often attended with symptoms strongly indicative of 
a deranged state of the chylopoietic viscera. The suffused complex- 
ion, and foetid breath point out the disordered state of the Stomach 
and bowels — the tongue is tremulous, and covered with a white slime, 
the appetite is impaired or depraved — the bowels are constipated, and 
sometimes in an extraordinury degree ; — but nothing is more remarka- 
ble than the fetor which taints the atmosphere of the patient. It is 
most offensive when the alvine constipation has been of longest dura- 
tion. If the abdomen of a patient labouring under an acute parox- 
ysm be examined, it will commonly be found tumid, especially in the 
region of the epigastrium. But whether this disease has its origin in 
gastric or cerebal derangements primarily, the treatment is equally ob- 
vious. The brain is highly excited, and the following symptoms 
point out the great determination which takes place to this organ. 
Inflammatory affections of the eye and other parts of the body, are 
known to subside upon the approach of this disease, and the pulse in 
highly excited cases, is frequent and small. The vivacity and strength 
of the patients perceptions, the increased energy of the imagination, 
his restlessness, his loquacity, all denote the brain to be in a high- 
ly perturbed state, and the action of its vessels greatly increased. 
The great insensibility to impressions, and to the actjon of medicines 
prove how much the equilibrium of the sensations is disturbed, and 
their concentration in the cerebrum. In whatever light, therefore, the 
origin of these diseases is considered, the great utility of this class of 
medicines is equally conspicuous. If from a deranged state of the 
Intestinal Canal, their great efficacy cannot be questioned, — if from 
excitement of the vascular system of the brain primarily, Cathartics 
by their depleting and revulsive action tend greatly to lessen and di- 
vert its effects. From the insensibility of the system to impressions, 
and the torpidity of the Stomach and bowels, the means we employ 
should be of a very active nature, and accordingly drastic purgatives 
are required. To show the influence of Cathartics upon the brain, no 
diseases so frequently alternate as Mania and bowel complaints. 



CXX1. 

In Epilepsy Cathartics have been employed with great success. 
This disease is connected with great mobility of the system — very 
often with irritation in the intestines. Thus it is produced by worms, 
by the sordes in dysentery, by poisons, by repelled eruptions, and very 
often by constipation of the bowels. The treatment, when connected 
with any of these causes, is not only to evacuate the bowels, but to 
continue the Cathartics from day to day unless imperiously forbid by 
circumstances. By this practice more cures have been effected than 
by any other, and I believe that in conjunction with other means, as 
attention to the state of plethora in the vessels, with a regular system 
of dieting, many cases may be effectually cured. 

In the treatment of Apoplexy these agents are equally conspicu- 
ous. Employed before the accession of the disease, they are capable 
of preventing this distressing complaint, and they are suitable when 
it exists. This disease exhibits itself generally in an undue distension 
of the vessels of the head, and its proximate effect would seem to 
consist in compression of the brain, produced either by the distend- 
ed blood vessels or an extravasation of blood. If effusion has not 
taken place, Cathartics are useful with other means, as general and 
local bleeding, with irritating applications to the extremities, to lessen 
this determination to the head, to dissipate this disordered state and to 
re-establish its freedom of action. The purging, to be effectual, must 
be copious, and produced by the most active medicines. Even when 
there is effusion upon the brain, producing the symptoms of compres- 
sion, the action of purgatives upon the surface of the Intestinal Canal 
is always advantageous : but their power to contend against this state 
of the brain is unfortunately very limited. The consequences of 
Apoplexy are very various, and purgatives are frequently required to 
contend with them. With these remedies we remove the obstinate 
constipation which torments the sick and which announces a dimin- 
ution of the nervous influence upon the intestinal structure. The 
Canal is in a state of torpor in these cases, and it becomes necessary 
to make a strong impression upon it, to excite its action. It is ne- 
cessary to employ active Cathartics, and the doses must be increased 
to obtain alvine evacuations in a sufficient degree. 

In Paralysis, as induced by the same causes as Apoplexy, the same 
remedies are equally beneficial. Active articles are effectual here, 
and as auxiliary, nothing is better than blisters or issues. To be ef- 
fectual they must be applied to the back of the neck, the back of the 
ears, or what is preferable, the crown of the head. 

In Hydrocephalus Intemus, purgative medicines have been highly 
commended. Of late years this disease has been referred to the dis- 
ordered condition of the alimentary canal, and the vitiated condition 
of its contents. In post mortem examinations of hydrocephalic pa- 
tients, there has been found in the liver, the remains of great inflam- 
matory action, and also proofs that undue irritation had existed in 
the alimentary canal. Mr. Abernethy declares, that in similar exam- 
inations of cases that had died with unequivocal symptoms of hy- 
16 



CXX11. 

drocephalus, he found the brain perfectly healthy, the only diseased 
appearance being in the bowels. Other proofs might be adduced, but 
I shall content myself with remarking that whatever be the patho- 
logical views entertained, purgative medicines are among the most 
important of our remedial resources. They remove t,he remote cause 
of disease, and determine the flow of blood from the brain. They 
may from all that has been said of their application to disease, be 
considered as exercising a more powerful effect in lessening the ac- 
tion of the vessels of the head, than any other internal remedies we 
can employ. 

I shall speak of the utility of Cathartics in Dropsies, with a view 
of bringing before you, the action of these medicines upon a system 
of vessels, to which allusion has not been made; these are the absor- 
bents. The action of Cathartics in promoting that of the absorbents 
depends upon the copious secretions which take place from the sur- 
face of the intestines, occasioning a deficiency of serous fluids in the 
blood-vessels, and a consequent effort in the powers of the system to 
restore the deficiency which has taken place. But it is not only by 
this process that the fluids are evacuated — the action of these medi- 
cines is extended to every part of the body, they increase the energy 
of the absorbents, and they augment in this manner the discharge of 
urine. The practice of using Cathartics in Dropsies has been of very 
ancient date, and it probably may have been suggested by the occa- 
sional natural cure of Dropsy by a spontaneous diarrhsea. Hippo- 
crates, in several parts of his writings, notices the salutary effects of 
such a diarrheea in the beginning of Dropsy. However the practice 
originated there are certainly no means in our power of procuring a 
copious evacuation of serous fluids more effectually, than by the oper- 
ation of purgative medicines, and none, perhaps, more successfully 
employed in the cure of Dropsy. The relief is generally in propor- 
tion to the quantity of fluids discharged, whence it is the custom to 
employ purgatives of the more active or drastic kind. The employ- 
ment of them should be regulated, however, with some caution and 
discrimination. Where the constitution is obviously much broken 
by age, long continued disease, or intemperance, all violent operations 
and copious discharges will be detrimental ; they will tend but fur- 
ther to weaken ;he body and to render it less able to support the rava- 
ges of a severe disorder. When the age, habit, strength and other 
circumstances of the patient admit of their use, they may.be very 
beneficially resorted to. The form of dropsy to which they are most 
successfully adapted is ascites. The watery fluids discharged by 
purging in this state, are evacuated from branches of the same arte- 
ries which pour out water into the abdomen, and the stimulus of the 
purgative is most directly communicated to the absorbents of the ab- 
dominal surfaces. There are cases of dropsy attended with so much 
organic disease that purging alone cannot relieve them. The use of 
mercury is very beneficial in these cases. 

I might thus continue to enumerate various other diseases in which 



CXX111. 

Cathartics are indicated, or afford relief — but the description would 
only cease with the detail of the diseases incidental to the human 
body, for there are few or none, in which beneficial effects do not 
follow their use. Having, however, pointed out the nature of their 
operation, with their positive and relative effects, and the application 
in the diseases of most common occurrence, I proceed to the consider- 
ation of the individual Cathartics. 

Particular Cathartics. 
In treating of this division, I shall pursue the same order as in the 
consideration of Emetics, arranging the articles of the class into 
Vegetable and Mineral Cathartics. 

Family Euphorbiacece. — Of the vegetable the first that I shall treat 
of is the Oleum Ricini or Castor Oil. This is the product of a plant 
the Ricinus Communis or Palma Christi, a native of both Indies. It 
grows very well in most parts of the United States. The seeds are 
the part which furnish the oil, and in consequence of their being va- 
riegated with dark and light stripes, like the Ricinus or Tick, the 
plant has been called by the same name. 

Description of the Plant. 
Stem round, thick, purplish red colour, and rises to the height of 
6 or 8 feet. 

Leaves large and deeply divided into 6 or 7 lobes. 
Flowers in spikes, male and female flowers separate — the males 
form the lower part of the spike, the female the upper. 

Stamens numerous, styles three, capsules three celled, seed solitary. 
Preparation of the Oil. — It is obtained from the seeds by expres- 
sion and decoction. That procured by the former of these modes 
without heat, and denominated in the shops " cold drawn oil" is the 
best. It is limpid and destitute of smell and colour. The oil obtained 
by decoction is not so pure, it is more nauseous, dark coloured, sooner 
becomes rancid, and is more active in its operation. 

It is prepared by decoction in the following manner. The seeds 
are bruised in a mill or mortar, thrown into a large kettle or boiler of 
water, and the whole is then boiled until the oil is separated, and 
floats upon the surface — an attendant skims it off as. fast as it sepa- 
rates, and from time to time deposits it in a suitable vessel until all 
the oil is collected from the seeds. This is the red or Jamaica oil, and 
from its containing a portion of the oil of the shell, is more active 
than that obtained by expression. It should be observed that in the 
shell surrounding the pulp there exists an oily substance, extremely 
acrimonious, and which acts as an irritating Emetic and Cathartic. 
The process may be improved by separating the husk from the 
pulp and boiling as above. The oil thus obtained would be of a 
lighter colour and less acrimonious. 

By expression. — When this process is td be employed, the seeds are 
spread out upon platforms, or in an airy building, and the surfaces 
exposed to the atmosphere frequently changed. As the husk dries 
it becomes very brittle, and when perfectly dry, splits, and leaves the 



cxxiv. 

pulp. When all the husk, by this means, has been separated, the 
seeds are collected into heaps, and when they are to be expressed, 
are first heated in an oven constructed as a bakers, carried to 110 Q 
of Fahrenheit. When sufficiently heated they are taken out and re- 
moved to a mill press, for the expression of the oil. The press is 
constructed like a cotton press, with a screw passing through a beam, 
turned by animal power, and the end adapted to a plug, which is 
accurately fitted to a cast iron cylinder. As the seeds are compressed 
the oil escapes through small openings at the bottom of the cylinder, 
and is conveyed off by a tube or pipe leading to a proper vessel. 

In this state it is impure and contains much amylaceous matter. 
It is separated by several means — by rest the fecula or farinaceous 
matter will subside to the bottom of the vessel, and the fluid above 
become clear. 

Or the surface of the oil may be spread over with chalk, sulphuric 
acid sprinkled upon it, and as it subsides it carries the impurities in 
the oil along with it to the bottom. The cake which remains after 
the separation of the oil, may be boiled, and from it a portion of in- 
ferior oil can be obtained. 

An acre yields 6 bushels of seed. 

From a bushel of seed a gallon and a half of good oil can be ob- 
tained, and half a gallori of inferior oil. 

I have observed that the seeds must be separated from the husk 
which invests them, as it possesses a great deal of acrimony, and acts 
as an Emetic, and irritating Cathartic. Its effects in this way have 
been noticed by most writers on the Materia Medica. 

Medical uses. Castor oil is probably one of the mildest and most 
extensively employed articles of the Materia Medica. It is so inno- 
cent in its operation, and at the same time so salutary, that it is ad- 
ministered without hesitation in the commencement of sickness, and 
is one of the substances most commonly resorted to before profession- 
al aid is required. It does not stimulate the bowels to any great 
degree, nor occasion griping, but operates gently, and where the 
system is but slightly disordered, it commonly is most sufficient to re- 
establish a healthy action. In the diseases of children it is particu- 
larly valuable, and to their cases the strength of its impression is 
peculiarly well adapted. There are few articles, which for common 
purposes could supply its place, and fewer still which in the hands 
of the common people, who interfere so largely in the diseases of this 
interesting portion of the species, can so safely be trusted. 

It is not however to their cases that its use is limited, but in many 
of the intestinal affections of adults, it exhibits no less valuable and 
agreeable effects. As it does not stimulate the bowels very greatly 
or gripe, it is admirably calculated to keep them open in sedentary 
and costive habits. To these cases it is well adapted, as the resinous 

Cathartics increase costiveness, and lose their effects by habit 

whereas it is observed of Castor oil, that if it be frequently repeated, 
the dose of it may be gradually more and more diminished, and it 



cxxv. 

always leaves the bowels in a loose state, — having, in this respect, a 
great advantage over salts. 

It is particularly suited to cases in which more irritating purga- 
tives would prove hurtful, as in nephritic and calculous affections, after 
injuries, and surgical operations, in w hich the abdominal viscera are 
concerned. 

In the various grades of colic, its use is too well known to need 
particular attention here — but we cannot trust to it when large evac- 
uations are required, for it will insinuate itself through the intestines, 
bring with it only their more fluid contents, and leaving the indu- 
rated feces. When used in such cases it should be several hours 
after the exhibition of a dose of Calomel and Jalap. Thus exhibited, 
it promotes purging, and mitigates the harshness of the drastic 
medicines. 

Castor oil is much used in the early stages of Dysentery. In these 
cases it lessens the griping and general distress, diminishes the tenes- 
mus, and the frequent desire to evacuate the intestinal canal. I have 
commonly found that more benefit was derived from more active Ca- 
thartics, as Calomel and Rhubarb or Jalap. I have never observed 
that the action of these articles increased the irritation of the bowels, 
but on the contrary, by expelling the morbid contents, which milder 
medicines could not effect, the greatest benefit has been derived. 

Castor oil is the basis of a formula called the Oleaginous mixture, 
which is much employed in the diseases of the bowels. It is pre- 
pared as follows — 
#. 01. Ricini, fii. 
Saccharum Album, pii. 

Mucilage Gum Arabic, f i. to be well rubbed together, add slowly 
Water, f v. 
Laudanum, 3SS. to %i. Dose, |ss. to fi. pro re nata. 

In place of Gum Arabic the yolk of an egg, or a thick emulsion 
of Almonds, or honey may be employed to promote a union between 
the oil and water. Thus prepared the taste of the oil is disguised, 
and we have formed a very useful mixture. 

Besides these diseases, Castor oil is much used in haemorrhoids, 
hEemorhages, calculus, and in the diseases of parturient women. 

Modes of Exhibition. — This oil, though so valuable in many dis- 
eases, and capable of fulfilling so many indications, yet is often re- 
jected, from the prejudices which exist against it, proceeding from 
its nauseousness, and the difficulty of swallowing ' it. It may be 
given floating upon Tincture of Senna, or peppermint water, or some 
other vehicle — it is sometimes given in coffee, or mutton broth, in tepid 
milk, in lemonade, or in any aromatic water, in the Comp. Tinct. of 
Senna. This last answers very well, as when blended with the oil 
by agitation, it conceals its qualities and increases its operation. 

The dose is an ounce for an adult, and for the youngest child, under 
ordinary circumstances, a tea-spoonful. In urgent cases it may be 
increased to a great extent. 



cxxvi. 

Adulterations. — This oil is frequently adulterated with Olive or 
Poppy oil. There is a peculiarity about Castor oil, (says Mr. Brande) 
which will serve to distinguish it from any other fixed oil, viz. its 
great solubility in highly rectified spirit — for instance f iv. of alcohol, 
will mix uniformly with any proportion of Castor oil, whereas it will 
not dsssolve more than 31. of Linseed oil. This then will serve to 
detect the adulteration. 

Family Euphorbiacea. — Croton Tiglium. — The next article to be 
considered is Croton Oil, obtained from the seeds of the Croton Tigli- 
um. This medicine which has lately been introduced as new, is an 
article the medicinal properties of which were long known. It will, 
in this instance, be observed that most of our new discoveries will 
turn out to be nothing more than the revival of ancient practice. 
So late as the year 1649 the plant was described in a work written 
by Jacob Bobart, and entitled, a history of the plants of the Univer- 
sity of Oxford, and his account is said to have been very accurate. 
It was afterwards described by several other distinguished persons, 
as Linneeus, Bergius, and others, and the medicinal qualities of the 
plant fully explained. As it has lately been revived and introduced 
into practice, a short account of its history will be proper in this 
place. 

The Croton Tiglium, (English term purging Croton,) is a native 
of the Island of Ceylon, but it has been found in Malabar, China, and 
the Molucca Islands. It is a small tree, seldom exceeding the height 
of ten feet, and is covered with a smooth bark of a greyish colour. 
The seeds of this plant, or the expressed oil of them, when taken 
internally, act as a very powerful hydragogue cathartic, and hyper- 
catharsis is frequently produced. Given in the dose of a drop of the 
oil, or a single seed, it purges very actively, and in particular cases 
with such energy, as not always to be safe. It is said, that the natives 
of Ceylon, particularly the poorer classes, generally take one of the 
seeds for a dose. The effects of one of the seeds when chewed and 
swallowed, are thus described by Dr. Bigelow, in a note in his Sequel. 
It produces no immediate unpleasant taste, but when swallowed a 
sensation of heat came on in the fauces and throat — this feeling ex- 
tended to the stomach and bowels, and in less than half an^ hour, a 
violent cathartic operation commenced which was repeated more 
than twenty times in three hours. When the oil is applied externally, 
it generally produces a great degree of local inflammation, which 
does not subside for many hours and sometimes days. The violent 
action which the oil produces, may be diminished by conjoining with 
it an aromatic, particularly any of the aromatic oils. Another mode 
of lessoning the action of the oil is by roasting or baking the seeds 
previous to obtaining the oil from them.* 



* Mr. Pope recommends a new method of preparing the Croton Tiglium, by 
which its efficacy as a Cathartic is unimpaired, while its acrid and irritating qual- 



cxxvn. 

Croton oil is recommended incases where a very active cathartic is 
required, as in obstinate constipation, when there are no inflammatory 
symptoms to contra-indicate its use. I have no doubt that the oil 
may be used with advantage, if administered with caution. 

In maniacal cases its use has been attended with success, and from 
its irritating action upon the stomach and bowels is doubtless well 
adapted to them. 

By the natives of India it is used as a drastic cathartic in dropsy, 
and it is even said to be effectual in expelling the Tape worm. In 
this latter disease, judging from the nature of the article, and its ef- 
fects I should be anxious to give it a trial. Where the tape worm 
has been expelled, it is by the drastic irritating quality of some article 
like the present. 

The Croton may be given in substance, in the expressed oil, and in 
tincture. In substance it is most violent, and therefore is seldom used. 

The oil may be given in the dose of a drop, which in particular 
cases, and under certain circumstances, may be augmented to two. 

The following formula is a good mode of exhibiting it. 

$. Oil of Croton, 1 drop. 

Oil of Caraway, 1 drop. 

Confection of Roses, grains iv. To be mixed and formed into a pill. 

The Tincture is made in the following manner. 

$. Croton seeds, bruised, 3ii. 

Alcohol, I pint. 

Triturate the seeds thoroughly with a small part of the alcohol, 
then add the rest — digest for 10 days, and filter the mixture. The 
dose is 31. 

Adulterations. — The Oil of Croton, from its high price, is fre- 
quently adulterated with Olive or Castor Oil. 

External Application of Croton Oil. — This oil has been applied 
externally as the Tartar Emetic. It produces an eruption much 
more speedily, one which is not attended with such suffering to the 
patient, and one which is very effectual. The eruption produced by 
the oil bears a considerable resemblance to chicken pox, that of Tar- 
tar Emetic to small pox. * 

Ten drops of oil are rubbed over the part steadily, and by two rub- 
bings an eruption will be obtained, but sometimes three or four are 
required. The appearance is that of a rash, with extended inflam- 
mation, uniform redness, and in the midst of this, there are many 
little vesicles about the size of a pin's head. Two or three may 
run together and be confluent, and then they will be large. They 

ities are obviated. These qualities exist in the husk or shell and the eye of the 
seed, the medulla being free from them. This is the part used by the natives 
of India as an ordinary purgative. The oil prepared from this part of the seed, 
may be given in substance, in pills or tincture, and is soluble in iEther and oil 
of Turpentine. 



CXXV111. 

do not contain clear, but puriform fluid, so that they are sometimes 
between vesicles and pustules. 

Thus employed it has been useful in Rheumatism, when other 
means had been unavailing. 

In affections of the heart, it has also been employed by rubbing the 
skin in the neighborhood of the part affected. Dr. Short, a surgeon 
practising in the East Indies, has employed it in this manner, and 
with advantage. 

It may be a useful article to restore repelled eruptions, scarlatina, 
measles, &c. Its external application has been known to produce 
purging. 



Family Euphorbiacea. — Euphorbia Lathyris, or Caper Tree. — It 
is commonly found in Europe, on the borders of roads and cultivated 
places. 

From the seeds of this plant, there is obtained by pressure, an oil 
which in common language is called oil of Spurge. It much re- 
sembles the Oleum Ricini, has the same colour, is a little less dense, 
has no odour and no bad taste. Its action upon the system is purga- 
tive, and its effects are sure and very prompt. It is said to be the most 
quick and safe of the newly discovered purgatives. It does not pro- 
duce vomiting, nor colic, nor tenesmus, and it may be administered in 
cases where there is intestinal irritation. 

It has been employed in Fevers, in Dysenteries, in anasarca when 
following Intermittent Fever, and in all cases where it is wished to 
purge lightly and with a small dose of medicine. 

The dose varies with the age. That for children 2 or 3 years old 
is three drops — for adults, four to eight drops. It may be united with 
the paste of Chocolate, or syrup, or in a wine-glassful of sweetened 
water. 

I have employed this article in costiveness, as an evacuant medi- 
cine, in two cases. In both instances three drops were given every 
two hours until 18 drops were taken in one instance, and 30 in an- 
other, with such little effect that it was discontinued. No unpleasant 
effects were produced from it, and the taste was not disagreeable. 

It is spoken of in terms of considerable commendation in Magen- 
die's Formulary, and it is possible that what was employed may 
not have been of a good quality. You may be more successful in 
your trials. 

This oil may hold an intermediate state between the Castor oil 
and the oil of Croton. 



Family Jasminece* — Olea Europcea — Olive Tree. — This tree grows 
to the height of 30 feet. 

Leaves firm, narrow, lance shaped, standing in pairs. 

* From Ja8minum, one of the genera comprehended under it. This order is 
remarkable for the fragrance and elegance of its flowers. 



CXX1X. 

The flowers are small, white, numerous, found in clusters near the 
footstalks of the leaves, flowering from June until. August. 

With the fruit, all are acquainted, which when preserved adds 
much to the pleasures of the table. 

Oleum Olivarum is the product of the Olive tree, a native of the 
South of Europe, and the north of Africa. It is cultivated in France, 
Spain, and Italy for the sake of .the fruit and the oil expressed from 
it. The oil is obtained from the fruit by bruising, and pressure, so 
regulated as not to break the kernels of the Olive. 

It is employed in diseases externally and internally. As an exter- 
nal application it has long been the custom in Italy to anoint the 
body with it in Fevers, and the practice is strenuously recommended 
by the physicians of that country. The effect of it when applied to 
the surface, has been, a speedy reduction of the force and frequency of 
the pulse. From some experiments made by a graduate of Philadel- 
phia, it appears that its application at four different periods during 
the space of 6 hours, reduced the pulse from 72 to 52 strokes in a 
minute. The experiment being repeated several times produced the 
same results. Upon this principle can we not account for the prac- 
tice of anointing the body with oil, so common among the inhabi- 
tants of hot countries. It is used in this manner by the people of 
Africa, and some parts of Asia — it is also a custom among the inha- 
bitants of the Islands of the Pacific Ocean. But its use in fevers is 
not confined to Italy. We are told that it is employed at Grand 
Cairo and at Smyrna in the plague. Of its utility in fevers of great 
morbid excitement, there can be no doubt, from the sedative influence 
exhibited in the experiment above related, and as the remedy is inno- 
cent, and the prospect of service from it favourable, a few trials of it 
should not be neglected. 

It has been employed externally in other diseases, particularly in 
Dropsy, and the success of the application in a number of cases, has 
been related by Dr. OHver, in the 49th volume of the Philosophical 
Transactions. Friction was in every instance joined with it, and it is 
difficult to say, from the known efficacy of friction in Dropsy, how 
much is justly to be ascribed to the oil itself. Since, however, from a 
more just pathology of this disease, Dropsy has been considered not 
only a consequence of fever, but a febrile affection itself, may not 
the oil from its sedative effects upon the sanguiferous system, equal- 
ize the excitability, and restore to the lymphatics their natural pro- 
portion. In every instance in which it was used, the quantity of urine 
was increased. 

Olive Oil united with lime water, in equal proportions, forms an 
excellent application to burns, being extremely soothing and pleasant ; 
and it enters largely into the composition of various cerates for 
wounds. It is also applied to parts inflamed from the bites of veno- 
mous insects. 

Taken internally it is a mild and pretty certain laxative, having 
all the properties of the former article without being so offensive. It 
17 



cxxx. 

may be used in all the diseases in which Castor oil has been em- 
ployed, and it is said to be decidedly preferable in cases of colic in 
children, and when poisons have been taken. It may be given in 
large doses, to children, a table-spoonful every hour, and in cases of 
poisoning to any extent. In obstinate constipation it has succeeded, 
after very drastic purgatives had been employed without success, 
and is therefore deserving of a trial before recourse is had to severer 
measures. Several cases are recorded of the utility of this article in 
obstinate constipation, and in particular after very severe remedies 
had been tried without effect. One reason of its efficacy is, that rely- 
ing upon its mildness very large quantities are administered, and in 
this manner insinuating itself into the bowels, it gradually softens 
down the indurated feces, allays irritation, and by its stimulus being 
adapted to the excitability of the surface of the canal, may allow the 
feces to pass onwards, when more stimulating articles would excite 
contraction, and thus restrain them. For these reasons it should 
always be employed before resorting to the Tobacco injection. 

Olive Oil has been recommended when the mineral poisons have 
been taken, but I believe it possesses no peculiar advantages, and that 
our hopes of correcting their operation must depend upon Chemical 
resources. 



Family Jasmines — Fraxinus Ornus, or Flowering Ash. — Manna 
is the product of the Fraxinus Ornus, a tree greatly resembling our 
common Ash. It is a native of the Southern parts of Europe, par- 
ticularly of Sicily and Calabria. In Sicily this species of Fraxinus 
is cultivated for the purpose of procuring the manna, and after acqui- 
ring a certain age, it yields a sweetish juice in considerable quantity, 
which concretes upon exposure to the air. The Ash is not the only 
tree which yields a fluid of this nature. Many others may be enu- 
merated, as the Maple of our country, and in others, the Larch, the 
Walnut, &c. In all it may be considered as a part of the Sugar so 
universally present in vegetables, and which exudes upon the surface 
of a number of them. Although the Fraxinus yields this juice spon- 
taneously, to which the name of Manna is given, yet incisions are 
made into the bark, in order to obtain it. in a more considerable quan- 
tity. When these incisions are made, a whitish juice begins to flow, 
which gradually hardens on the bark, and in the course of eight days, 
acquires the consistence and appearance in which Manna is imported 
into this country. The different qualities of Manna, depend upon the 
different impurities which become mixed with the juice, and the cir- 
cumstances under which it is obtained from the tree That which ex- 
udes slowly is always more dry, transparent, and pure, and conse- 
quently more esteemed. In its chemical composition it consists of 
sugar, mucilage and extractive matter, to which its taste and other 
peculiar properties are owing. 

Manna is well known as a gentle purgative, so mild in its opera- 
tion that rt may be given with safety under any circumstances It is 



CXXX1. 

however, in some constitutions apt to produce troublesome flatulence, 
heart-burn, &c, on which account it is seldom used alone, but render- 
ed more active by combination with some other cathartic of a more 
powerful nature, as senna, or salts, or both — Vide Formula in the 
Syllabus. Thus employed, its activity is increased, and at the same 
time it acts as a corrective, and lessens the irritating operation of 
other cathartics. It is therefore much employed for children com- 
bined with magnesia, rhubarb, salts or jalap. It is however a medi- 
cine less prescribed by physicians than formerly, though much in 
vogue with nurses. 
Dose, fi, to fii. 
When given to children alone, I direct as much as they will eat, 
which is usually about ^ss. 

Family Leguminosce* — Cassia Senna. — The genus Cassia contains 
many species. They have been distinguished by modern botanists 
-into Cassia Acutifolia — C. Obovata — C. Lanceolata. The first is 
the best Senna is a native of Egypt, it also grows in some parts of 
Arabia, particularly about Mocha — but as Alexandria has ever been 
the great mart from which it has been imported into Europe, it has 
long been distinguished by the name of Alexandria Senna. 

The leaves are of an oblong figure, pointed at the ends, about a 
quarter of an inch broad, and not a full inch in length, of a lively 
yellowish green colour, a faint, not very disagreeable smell, and a 
sub-acrid, bitterish, nauseous taste. 

The Senna Italica or blunt leaved Senna, is a variety of the Alex- 
andrian species, which by its cultivation in the South of Europe, has 
been found to assume this change. It is less purgative than the 
pointed leaved Senna, and is therefore given in larger doses. 

Senna which is in common use as a purgative, was first known to 
the Arabian Physicians, and the first of the Greeks by whom it is 
noticed, is Actuarius, who does not mention the leaves, but the pods. 
Mesue likewise gives a preference to the pods, as being a more effica- 
cious cathartic — but the fact is the contrary, for it purges less pow- 
erfully than the leaves, though it has the advantage of seldom gri- 
ping the bowels, and of being without the nauseous bitterness which 
the leaves possess. 

The French Chemists in analysing this article have separated 
several principles, as follow — 

Cathartine. 

Fixed oil. 

Volatile oil. 

Albumen. 

Yellow colouring matter. 

Malate of Lime. 

Acetate of Potash. 

* From Legumen, a pod. 



CXXX11. 

The principal of these substances is Cathartine, an uncrystallized 
substance, which is said to purge in very small doses. 

It is of a yellow colour, of a peculiar odour, a taste bitter, and 
nauseous, soluble in water, ether and alcohol. 

Medical properties. — Senna is deservedly held in estimation as an 
active and sure cathartic. It is seldom given alone, or in substance, 
but combined with other cathartics, either to increase their activity or 
to lessen the irritating operation of its own action. The testimony 
in its favour is considerable. Dr. Fordyce in speaking of it says, that 
as far as he could judge from experience, it is the most certain stimu- 
lus to the bowels in producing purging, of any substance which he 
has ever tried. Dr. Cullen who was much opposed to it, admits that 
it is a very certain purgative, operating moderately and seldom to 
excess. The principal objection that is made, is its tendency to pro- 
duce griping. I do not think that it exists in a greater degree in 
Senna, than in the other resinous purgatives, nor is it more difficult to 
obviate. Senna, though objected to by a great many physicians, I 
have uniformly found an active article, and by no means harsh or 
severe in its operation upon the bowels. I never employ it alone, be- 
cause its active principle resides in a bitter extract, which is not very 
soluble. It is however sufficiently so, when united with any saline 
substance, to prevent any griping operation which would otherwise 
take place, and its activity is much increased. The manner of em- 
ploying it is the following — 

To an infusion of Senna prepared by pouring a pint of warm water 
upon f ss. of the leaves, I direct f i. or more of salts to be added, with 
fss. of Manna. 

The dose is a small tea-cupful every hour or two until it operates. 
Thus prepared it is an active and certain Cathartic, having succeeded 
with it, after Calomel, and Jalap, and other active articles had failed. 
It is not very nauseous — in general it agrees well with the stomach. 
In preparing the infusion of Senna it should not be allowed to boil, as 
the active matter is of a volatile nature, and it would be dissipated 
by the heat. The infusion will also spoil in 48 hours in warm wea- 
ther, and by being exposed to the air, the oxygen combines with the 
extractive matter and forms a yellowish precipitate, which gripes 
violently, but does not purge. On which account, the infusion when 
prepared, should be kept in covered vessels. 

There are no particular forms of disease to which Senna is adapted. 
It is resorted to, prepared in the manner I have mentioned, in removing 
costiveness, in cleansing the prims vis, and relieving thereby many of 
the constitutional derangements dependent upon these causes. In the 
advanced stages of disease it is also employed in small quantities, 
where we wish an alvine discharge without purging. 

For children,, an Infusion of Senna sweetened with sugar and with 
the addition of a little milk, given in the form of tea, is readily taken, 
and operates with much certainty. 

There has been a number of official preparations of this article, 



CXXX11I. 

but the forms of giving it, which have been mentioned, supercede 
them all. There is one preparation, the Comp. Tinct. of Senna, 
which is occasionally useful by being mixed with cathartic mixtures, 
in adding to their strength. For the preparation of it I refer you 
to the dispensatories. 

The dose is from 3H. to |ss. in any appropriate vehicle. 

This is the preparation with which I advised the 01. Ricini to be 
taken, and while it is palatable, the strength of the mixture is in- 
creased. 

There is yet another mode of using this article : — in the form of 
Enema. An infusion of the leaves is prepared stronger than when 
intended for its internal administration. In the quantity of a pint it 
is a very excellent and active article ; if necessary a little salts or oil 
may be added. 

Adulterations. — With the leaves of the Cassia Senna there is often 
mixed those of various other plants. For example 
Coriaria Myrtifolia. 
Ilex Aquifolium. 
Buxus Sempervirens. 
The adulteration takes place in the following manner. The 
leaves of Senna are collected twice a year, in August and September. 
The branches with the leaves are dried in the sun, and when fully 
dried, the leaves are stripped from the stems, and these last thrown 
away. They are collected by the poorer classes', coarsely pounded, 
and mixed with the leaves of other plants, and sent to Europe by the 
way of Alexandria. 

The seeds obtained from pods, often mixed wth the oriental Senna, 
would, if planted, afford a very good substitute for the imported article. 

There exists in this country a species of Senna, nearly allied to the 
foreign in all its properties, viz. — 

Family Leguminosce — Cassia Marylandica. — Description of the 
plant. 

Stems growing to the height of 5 or 6 feet, round. 

Petioles compressed, bearing 8 or 10 leafets. 

Flowers growing in axillary racemes. 

Petals five, bright yellow. • 

Stamens ten. 

Fruit, a long pod. 

It differs but little in appearance from the Senna of the shops, and 
from repeated trials of it, by practitioners in the country, it is found 
to be as safe and certain. It is said by some to be more apt to gripe 
than the imported Senna, a quality which may be in a great measure 
corrected, by infusing with the leaves a small quantity of liquorice 
root or any aromatic. In using it, the quantity employed is larger 
than in the preceding instance, about a third more, but the manner 
of preparing it and the dose are the same. 



CXXX1V. 

Family Juglandece — Juglans Cinerea. — The next of our native 
Cathartics is the Juglans Cinerea, or Butternut, also known by the 
names of Oilnut arid White Walnut. This tree grows in various 
parts of the union, principally in the Northern and Middle States, 
also the western part of our State and the Western country. It 
is of considerable utility, not. only for the purposes to which the wood 
is applied, but from the sap possessing a saccharine quality, and 
beins: furnished in considerable abundance. In the 3d volume of 
the Massachusetts Agricultural Repository is an account of an exper- 
iment made on this tree, by Mr. Gray. He states that 4 trees, the 
trunks of which were only from 8 to 10 feet in diameter, produced in 
one day, nine quarts of sap, from which was made one and a quarter 
pounds of sugar. 

The inner bark of the tree, especially that obtained from the root, 
affords one of the most mild and efficacious laxatives we possess. 
An extract is usually made from the bark which is not only a more 
convenient, but a more active preparation, and was much used during 
the revolutionary war, when the more expensive medicines could 
not be obtained. In the trials that were made of it, it was found to 
be a valuable medicine — since that time it has fallen into neglect. 

From numerous experiments with the article, Dr. Bigelow thinks 
that it is entitled to the consideration of a useful and innocent laxative. 
When fresh and properly prepared, it is very certain in its effects, and 
leaves the bowels in a good state. 

In cases of habitual costiveness, it is to be preferred to more stimu- 
lating cathartics, and many persons whose state of health has ren- 
dered them dependent upon the use of laxative medicines, have given 
this the preference after a trial of a variety of other medicines. 

The dose of the extract is from 10 to 30 grains, it is improved by 
combination with calomel in a dose of x. grains each. The extract 
is stronger when prepared from the bark in the month of June. 



Family Podophylla, — Podophyllum Peltatum, or May Apple. — It 
grows in every part of our country, and has attached to it a variety 
of names, as May Apple, Mandrake, Ipecacuanha, &c. Different 
parts of this plant are endued with different properties. The fruit is 
esculent — the leaves poisonous, and the root cathartic. The root is 
creeping and jointed, and when dry is bitter, and readily reduced 
to powder. Its taste is unpleasant, and when chewed for some time 
becomes intensely bitter. 

Description of the Plant. 

The stem is about a foot in height, is smooth, round and erect, divid- 
ing at top into two round petioles from 3 to 6 inches long^-each peti- 
ole supports a large peltate palmate leaf, divided into 7 lobes. In the 
fork of the stem is a solitary flower. The flower is followed by a 
large ovate yellowish fruit, which is one celled — Class polyandria. 



cxxxv. 

This plant is often confounded with another, the Passiflora Incar- 
nata, Class monodelphia, pent. 

The root of the Podophyllum Peltatum is one of the most effica- 
cious cathartics which has been discovered in this country. It is 
nearly allied to Jalap, and might very well be substituted for it. In 
doses of 20 grains it is a safe and active cathartic, and may be used 
either alone, or in combination with calomel and the Cream of 
Tartar. 

It has been particularly recommended in dropsy, to which disease 
it is well adapted by the large evacuations it produces, and it has 
also been employed in cases of Intermittent and Remittent Fevers. 

The P. P. is less known to us than it deserves. Dr. Zollickoffer, 
a physician of Baltimore, who has been in the habit of employing 
this root for sometime, gives it a preference to Jalap. Twenty grains 
in the generality of pases, he says, will be sufficient to operate as a 
cathartic, but the dose may be increased to 30 grains, without its 
being attended with any drastic effects. It will never be found to 
give the least uneasiness to the patient, when it is combined with 
Calomel, in the proportion of 10 grains each. A watery extract 
may be prepared from the root, the dose of which is from 6 to 10 
grains. 

I have experimented with this article in a sufficient number of 
cases to determine upon its efficacy. It appears to act with consid- 
erable energy, and to be, as far as I may be allowed to judge, of more 
decided activity than Jalap — not being more liable than that article 
to produce griping, pain, or other irritating operation — Being readily 
obtained, and not liable to adulterations, it may with more certainty 
be resorted to, and in every respect may with great propriety be sub- 
stituted for Jalap. 



Family Convolvulacem* — Convolvulus, or Ipomta Jalapa. — Jalap is 
a vigorous plant with a fusiform root, white, fleshy, lactescent, giving 
origin to a number of shoots, which run to a considerable height. 

Leaves alternate, petiolated, subcordiform, acute, entire, or often- 
times divided into 2, 3 or 5 lobes, glabrous above, and of a violet 
structure beneath. 

The flowers are solitary, axillary, and of a violet colour. 

The Jalap root acquires a considerable size, but most commonly 
they are about the weight of a pound or less. They are found 
in the shops cut into hemispherical pieces, or round, about the size of 
two or three inches in diameter. 

The plant is a native of South America, and is to be found grow- 
ing in considerable quantity about the city of Xalappa in Mexico, 
whence its name is derived. It is also found in Vera Cruz. 

The roots of this plant when dried, are of an oval shape, solid, 
ponderous, blackish on the outside, but grey within, and marked with 

* From convolvo, to entwine, to wrap round. 



CXXXV1. 

several veins, by the number of which, and its hardness, heaviness, 
and dark colour, the goodness of the root may be estimated. 

The chemical analysis of Jalap present us with several principles. 
The most important are — a resinous matter, a gummy extract, a 
ligneous .principle, several salts, &c. 

The analysis of 500 grains of Jalap furnishes us with the following 
principles — Water, 24 grains — Resin, 50 grains — Gummy Extract, 
220 grains — Starch, 12 grains — Albumen, 12 grains — Ligneous mat- 
ter, 145 grains — Phosphate of Lime, 4 grains — Muriate of Pot. If — 
Carbonate of Lime, 2 grains, &c. 

The purgative property of Jalap appears to reside in the resinous 
matter which it contains, but it exists in different proportions in dif- 
ferent roots. On this account, much irregularity occurs in the opera- 
tion of this medicine — an ordinary dose frequently exerting a brisk 
cathartic action, and in another parcel a very feeble effect is produced. 
The difference in these results is explained upon the variations which 
often take place in their intimate composition. These are dependent 
upon the diversity of soils in which the roots are planted, on the state 
of the plant at the time it is dug up, or on the season of the year. 
The gummy part bears a considerable proportion to the resinous, but 
has little or no cathartic power. 

Medical uses. — Jalap is unquestionably a very efficacious and safe 
cathartic, and as such was employed by the Mexicans, previous to 
the discovery of America. It was not introduced into Europe 
until about the year 1610. In point of utility, and the purposes to 
which it is applied, either according to the dose in which it is given, 
or its combination with other medicines, it bears the same relation to 
cathartic substances, that the Tart. Antimony does to the rest of the 
Emetics. 

It is not so powerful as some others, but it can be resorted to in a 
greater variety of cases, and the readiness and facility with which it 
operates, with the beneficial effects which follow its use, justly entitle 
it to be considered as a very valuable article. 

Jalap, however, is rarely given alone, but is combined with other 
medicines of the same nature, either with a view to quicken its ope- 
ration, to obviate its griping quality, or to enlarge the sphere of its 
activity. 

The cathartic, I greatly prefer for ordinary purposes, is a combina- 
tion .of the Sulphat of Potash with Jalap, in the proportion of 10 
grains of each, united into a powder, and repeating it every two hours 
until it operates. To this may be added any aromatic oil, as cinnamon 
or anniseed to prevent griping, though this rarely takes place, and 
any addition of this nature often impairs its activity. Where free 
catharsis is required, I do not know a better formula. The action 
of the Jalap is much quickened by the addition of the Salt, and by 
being carried rapidly through the bowels, but little griping follows. 

The doses are usually repeated two or three times before catharsis 
takes place, and from the free discharges which follow its use, it is 



CXXXVll. 

well calculated to excite and sustain an impression which greatly 
relieves tiie more prominent symptoms of disease. When we wish 
to deplete the liver, and promote discharges of bile, a few grains of 
Calomel may be added to each dose. 

Combined with Calomel it forms a very useful and effectual pur- 
gative, and from its tendency to deplete the biliary sj^stem, and to 
produce powerful and free discharges from the bowels, it is much 
reported to in the beginning of Fevers, or in other derangements of 
the system, Ii was the favorite formula of Dr. Rush, in the treat- 
ment of Yellow Fever, ana in the bilious fevers of our country. 
The proportions which I prefer employing are 10 grains of Calomel 
to 15 or 20 of Jalap. This ensures free action upcn the bowels, and 
prevents salivation. 

The same combination was also recommended as an anthelmintic, 
- and as a hydragogue, anr 1 from its efficacy in dropsy was called the 
Panacea Rydropicorum. 

In the treatment of dropsies this combination has been superseded, 
and in the place of Calomel, the Bi. Tart, of Pot. is substituted. 
Given in the proportions of pi. of the Bi. Tart, of Pot. and 15 
grains of Jalap, a very useful cathartic is formed, and from the ex- 
halents of the intestines being excited in a considerable degree, very 
copious discharges are produced, with an abatement of the dropsical 
effusions in the cavities of the body. For by evacuating the serous 
portion of the blood, a demand is made to supply the expenditure 
from otner part? of the system, and the absorbents are therefore ex- 
cited to a more vigorous action, to supply the deficiency which the 
purging has produced. Combined with a few grains of Ipecacuanha 
its purgative properties are very much increased. 

Triturated with hard substances, as the crystals of Tartar, or 
sugar, by which it is reduced to a very fine powder, it operates in 
much smaller doses than when taken by itself, and at the same time 
it is very mild in its action, and does not gripe. With sugar, especi- 
ally, it becomes a very safe article for children, which in this form 
they will readily take, as the Jalap itself has not much taste. 

I have already expressed myself upon the value of medicinal 
combinations, of the good effects of which, this article affords an 
excellent illustration. 

The preparations of Jalap in use, are a tincture, resm and extract. 
They are prepared according to formulae to be seen in the Dispen- 
satories. 

The Resin of Jalap — Its fracture is shining, its taste at first feeble 
soon becomes acrid and disagreeable. It is rarely found pure, being 
often mixed with resins of inferior value, especially the resin of guaiac. 

The resin of Jalap produces the same effect as the powder, but in 
doses necessarily much smaller. The facility of administering it, in a 
small volume, and of disguising its taste, and especially the accuracy 
with which we can measure the quantity of this active principle, 
might cause it to have a preference in ordinary use to the entire root. 
18 



CXXXV111. 

In small doses, it excites sometimes colic, and even hyper-catharsis. 
It is given in doses of 1 to 2 grains to children, and from 6 to 10 
grains to adults, united to a powder of a softe*ning nature, as Gum 
Arabic or liquorice root. It is also united with Calomel, but most 
commonly employed- in the formation of bilious and cathartic pills. 

The Tincture of Jalap is a popular preparation. 

Jalapine. — Mr. Hume thinks that Jalapine exists in Jalap in the 
proportion of 5 grains to the ounce of the root. Mr. H. having sent a 
specimen to M. Pelletier, which he designated the Sulphate of Jala- 
pine, that distinguished chemist, after various experiments upon it, 
concluded that the substance sent was not a salt, but a mixture of 
acetic acid and resin. 

Adulterations — Jalap is sometimes adulterated with the Briony 
root, but it may be distinguished by its paler colour, and less com- 
pact texture. 



• 



Convolvulus Macrorhizus. — I have introduced this plant to your 
notice, not for its medicinal importance, but because it is the plant 
which has been described by several botanists as that which affords 
the officinal Jalap. The elder Michaux, a celebrated French Bota- 
nist, cultivated it at a small farm, in the neighborhood of this city, 
and specimens were sent by him to the Jardin des Plants, in Paris, 
where it was figured and described as the plant from which Jalap 
was obtained. Other botanists have also expressed themselves in 
similar terms, as Pursh, Persoon, Linnaeus, &c. I have thought it 
right to present it to your notice, and by furnishing you with a draw- 
ing and the root of the plant, to form a comparison with the one de- 
scribed by Prof. Coxe, as the real Jalap, and by this means be convinc- 
ed of the error which has existed on this subject for a long time. The 
error has been corrected, by the industry and patience of Prof. Coxe, 
in cultivating shoots sent him from Mexico, and from it an engraving 
with a description of the plant, has been given, in one of the No's. 
of the American Journal. * 

The following is a description of the C. Macrorhizus. 

Leaves cordate, simple and lobed. 

Root perennial, very large, when old weighing from 40 to 50 pounds. 

Stem, twining about shrubs and fences. 

Corolla, large, border obscurely 10 lobed, light pink, tinged on the 
inside with purple. 

Not only are the external characters of these plants different, but 
the medicinal qualities are equally so. The late Dr. Baldwin, of 
Georgia, experimented with the root, with a view to its medicinal pro- 
perties, and found that 3vj. may be taken without any cathartic ope- 
ration being excited. 

In addition, the root contains a great deal of saccharine with a 
considerable quantity of farinaceous matter. Upon submitting it to 
analysis, it is found to contain so little resin as not to prevent its 
being used as an article of diet. 



<r* 



CXXX1X. 

Convolvulus Scammonia, or Scammony. — It is the concrete juice 
of the Convolvulus Scammonia, a plant which grows in many parts 
of Asia, particularly in Syria. The root is the part which furnishes 
this substance, and it acquires a very great size. It contains a milky 
juice, which when collected, and allowed to become concrete, forms 
the substance of which I am speaking. 

The following is the method pursued in procuring it. The earth 
eing removed from about the root, the top of it is cut off in an 
oblique direction, about two inches below where the stalks spring 
from it. Under the most depending part of the slope, is placed shells 
or some other convenient receptacle, into which the milky juice 
gradually flows. It is left there about 12 hours, which time is suffi- 
cient for draining off the whole juice — this, however, is in small 
quantities, each root affording but a very few drachms. It is then 
allowed to become concrete, by exposure to the air and sun. 

The scammony which we receive is far from being the pure juice. 
Those who collect it, to increase its bulk, make various additions, as 
meal, ashes, sand, or other impurities. 

There are two sorts of Scammony to be found in the shops. That 
from Aleppo and from Smyrna. The former is the best, and it is 
brought to us in light spongy masses, easily friable, glossy, of differ- 
ent shades of colour, from grey or yellowish white to black. That 
should be chosen which crumbles most easily betwixt the fingers, 
becomes white on being united with water, and leaves little or no feces 
upon being difSBfrflgd. The Scammony of Smyrna is less valued, — 
it is more -heVvy, hard, and black, and is full of sand and other im- 
purities. 

The chemical analysis of this substance, by Bouillon la Grange, 
and Vogel, exhibits the following results — in 100 parts of Aleppo 
S. there are about -60 grains of Resin, 3 of Gum, 2 of extractive 
matter, 35 of inert vegetable matter, or an earthy substance. The 
analysis of the Smyrna S. exhibits less resin, and more earthy and 
foreign matters. 

Properties. — This article is one of the strong stimulating cathartics, 
operating in general quickly and powerfully. It appears to have 
been well known to the Greek and Arabian physicians, and was not 
only employed internally, as a cathartic, but also as an external ap- 
plication for scabies, taenia, &c. 

It has been used in cases of Dropsy, hypocondriasis, worms, and as 
a cathartic for ordinary purposes, and in many instances has been of 
decided utility. But it is sometimes unsafe from its violence, and at 
other times it exerts no action upon the bowels. This would seem to 
depend upon the intestines being lined with a great quantity of mucus, 
the medicine in this condition passing through, without exciting any 
action upon them, — but these different reports of authors may depend 
upon the variable quality of the drug. 

The dose of Scammony is from 3 to 10 grains. 

The general properties of this article are drastic and irritating, and 



cxl. 

it is not possessed of any virtues particularly worthy of attention, or 
which may not be supplied by others that have been or to be mentioned. 

Family Polygonea* — Rheum Palmatum. — The next article of 
which I shall treat is Rhubarb. This name is applied, in Pharmacy, 
to the roots of several species of plants, of the genus Rheum. Three 
species have been considered as furnishing the true Rhubarb of comt| 
merce, and they flourish in the eastern parts of Asia, (from whence 
they are brought,) comprehending the Asiatic provinces of Russia, 
Tartary and China. Linnaeus thought that the Rhubarb of com- 
merce was furnished by the Rheum Undulatum, hence he has termed 
it Rheum Rhubarbarum. Again it was thoughc to have been de- 
rived from the Rheum Compactum. At present all naturalists agree 
in considering it as derived from the Rheum Palmatum — more recently 
from the Rheum Australe. 

All the species of the genus Rheum are large herbaceous plants, 
having a thick compact root. Leaves radical, of a considerable size, 
petiolated, &c. 

Two species are particularly distinguished — the Rhubarb of China, 
and of Russia. 

The Rhubarb of China, called also Indian, Tartary, and Turkey 
Rhubarb, is received from China by the way of Canton. It is 
found in cylindrical pieces, of a dull yellow externally, and covered 
with a yellowish powder — marbled with hard veins, of a dull brick 
dust colour — its fracture is dull and rough — its odour strong and pe- 
culiar — its taste bitter — it is gritty to the teeth when chewed, which 
is attributed to the saline substances it contains — it tinges the saliva 
of an orange colour — it is heav} r , and the powder is of a fawn colour. 
Each of the pieces is pierced with a hole, through which has been 
passed a cord, by which they are suspended to the branches of trees, 
that they may be dried more effectually. As the roots perform a 
long sea voyage before they reach us, it is not uncommon to find 
upon them black spots, and partially damaged from moisture. They 
are then readily attacked by worms. The merchants endeavour 
to conceal the defects, by stopping up the holes formed by the worms, 
with a paste made of powdered rhubarb and watei. The fraud, 
however, is soon discovered. This species is less esteemed than the 
Russian, though it possesses active properties. 

The Russian Rhubarb is produced from the same plant, and culti- 
vated in the same places as the Chinese. It is onlj T so called because 
it is transported f v om Thibet, Bucharia, and other places f o Kiachta 
in Siberia, where it is sold to the merchants appointed for this pur- 
pose by the Russian Government. It is there examined with great 
care before it is conveyed to the capital of Russia, St. Petersburg. It 
is to the careful examination it undergoes, that the Russian Rhubarb 
is preferred, and sells higher than the Chinese. 

* Polus, many ; gonia, angle. From the angular appearance of the stem. 



cxli. 

Rheum Rhaponticum — Characters. — It is met with in pieces from 
3 to 4 inches in length, and from 2 to 3 in thickness. In appearance it 
is less ligneous, of a pale colour, a taste mucilaginous and astringent, 
with a little of the gritty sensation upon being chewed. This spe- 
cies grows upon the borders of the Caspian sea, between the Volga 
and Uralian mountains. It was the species' known to the Greeks. 

Rhubarb of Europe. — Characters. — Large pieces, longer than they 
are thick — odour disagreeable and nauseous — taste astringent, scarce- 
ly gritty between the teeth. 

Rhubarb, though it has been successfully cultivated in Europe and 
this country, still the roots in chemical composition and in their effects 
are not equal to those brought from their native climate. Their ca- 
thartic property is feeble, while ihey have more astringency. This 
difference partly arises from the age of the root. The English and 
French are commonly taken up after three years, in consequence of 
their decaying in the ground. The Eastern is not taken up until the 
seventh or eighth year of their growth. While the latter therefore 
possess a colour more fixed; — a stronger odour — a taste quite aromatic 
and slightly bitter — the former will be found to have a taste more 
mucilaginous and herbaceous, and evidently a less degree of strength. 

Notwithstanding what I have said of the distinctive characters of 
the different species, it is very difficult to determine, by the appear- 
ance of the roots, their real characters or qualities. Much deception 
is practised in selecting and artificially preparing the roots, so that 
the same species will frequently be sold for E. India, Russia, or Tur- 
kejr, and command corresponding prices. Dr. Paris states that infe- 
rior kinds of Russia, Chinese, and English Rhubarb, are artfully 
dressed up and sold under the name of Turkey, and he states that a 
number of persons in London, known under the name of Russifiers, 
gain a regular livelihood, by the art of dressing this article — by 
boring, rasping, and colouring the inferior kinds. 

Culture of Rhubarb. — Our knowledge respecting ^ie culture Rhu- 
barb in its own climate, is far from being accurate. All that is 
known being derived from a company of Bucharian merchants, who 
possess a monopoly of the trade, and who are interested in keeping 
every thing secret which relates to the plant. Having obtained this 
monopoly (from the Chinese Government) they export the Rhubarb, 
on one side into Russia, and on the other into China. 

It appears that the plant thrives best in light and sandy soils. 
The roots are collected twice a year, and those only are selected 
which have attained the age of 6 years. As soon as they are drawn 
from the ground they are deprived of their bark, cut into pieces, and 
suspended on strings, (in order to faciliate their drying,) in places 
well ventilated, but, protected from the rays of the sun. The desic- 
cation is a most important operation, for upon this in a great mea- 
sure depends the qualities of the Rhubarb, and by this process it 
loses about, four-fifths of its weight 

A second operation succeeds to this, and consists in cleansing the 



cxlii. 

roots afresh, dividing them into smaller pieces, and piercing them, not 
merely to suspend them in the air, but to ascertain that internally 
they were not damaged. 

In Canton the root is purchased directly from the agents of this 
company, by the English and other commercial people of Europe, 
and it is proverbial that the article is not selected with the greatest 
attention to quality at this place. On the contrary the greatest care 
is bestowed upon that which is forwarded to Russia. 

Chemical Analysis. — The Rhubarb of China has been the subject 
of considerable research to the chemists. The most recent analysis 
discovers the presence of a particular principle, which gives to it 
taste, odour and colour, and which is called Rhabarbarine. This 
principle is yellow, insoluble in cold water, soluble in boiling water, 
ether and alcohol — 2 of a free acid, which 'Thompson has called 
Rheumic — 3 of a fixed oil — 4 of a small quantity of gum — 5 of starch 
— 6 of many salts. 

The yellow colour of Rhubarb is much less destructible than 
many other vegetable yellows. Aquafortis and other acids which 
destroy the colour of saffron, turmeric, &c. makes no change on that 
of Rhubarb, or at most renders it only turbid. It resists the digestive 
process, and is observed in several of the secretions of the body. A 
few hours after it is taken it tinges the urine a high yellow colour, — 
it may be detected in the perspiration, and also in the mills* 

Medical uses. — Rhubarb has been long known as a valuable ca- 
thartic, and it derives much additional value in being applicable to 
purposes, for which other cathartics are not adapted. It is not pos- 
sessed of very active properties, but is gentle in its operation. On 
this account it is much employed in those cases of disease, where the 
patients are much debilitated, where the bowels are weakened by a 
long course of medicines, or when from constitutional peculiarities, 
other cathartics could not be employed. Being endowed with this 
most singular combination of medicinal powers, viz. an astringent with 
cathartic property, its virtues in many cases are much enhanced, and 
it becomes particularly useful in many of the forms of Intestinal 
disease. Its purgative quality is also accompanied with a sense of 
bitterness, which is often useful in restoring the tone of the stomach, 
when it has been lost, and for the most part its bitterness makes it 
sit better on the stomach than most other cathartics. From this view 
of the properties of Rhubarb, it may be supposed that it is not much 
employed in Febrile affections of adults, and where an impression is 
to be made upon the system. It is well adapted to the diseases of 
the alimentary canal, from simple costiveness, to the higher grades of 
diseased action, diarrheas, and dysenteries. 

In costiveness, depending upon feeble action of the alimentary 
canal, or upon the impaired energies of this organ, it is better adapt- 
ed than the variety of remedies which are resorted to for this pur- 
pose, which most commonly confirm the disease they were designed 
to prevent. It is sufficiently purgative to excite a gentle action, at 



cxliii. 

the same time it does not impair the energies of the primee via, but 
by its astringent and tonic properties, combined with the purgative, it 
establishes a habit of action, while it strengthens their functions. It 
is given in these cases in the form of a pill of 5 grains or more, at 
bed-time — or the root may be chewed, and the saliva swallowed. No 
practice is more to be deprecated than that of resorting to drastic 
stimulating pills, with a view of obviating a costive habit of. body. 
The various nostrums for this purpose consist of little else, which 
being comprised in a small compass, gratify a reluctance so natural 
to taking medicine at the expense of the health. For, let it be ob- 
served, that though evacuations are excited, yet being purchased by 
the use of very stimulating substances, the bowels become insensible 
to minor stimulating impressions, and have at the same time their 
powers of action impaired. The article of which I am speaking is 
subject to none of these objections — while it relieves the bowels, it 
tends to produce more regularity, by strengthening and giving tone to 
its fibres. In this affection the utility of habit is strongly exhibited, 
and while under the use of Rhubarb, it would be advisable to solicit 
discharges at a particular hour every day. 

In Dyspepsia the relief afforded by regular alvine discharges, is 
confessed by every one afflicted with that disease, and Rhubarb em- 
ployed in the manner above mentioned is highly useful. 

In Hypochondriasis, a disease which often has its origin in the im- 
paired condition of the primae vise, the utility of regular discharges 
must be apparent. The slightest attention paid to the origin and 
progress of this disease, evinces a deranged state of the bodily health 
in general, and especially of the digestive organs, which having con- 
tinued for a definite length of time, a state of mind gradually shews 
itself, distinguished by the following circumstances — languor, list- 
lessness, a want of resolution and activity with respect to all under- 
takings, a lowness of spirits, sadness, timidity, and with respect to all 
future events a dread and apprehension of the worafr or of most un- 
happy occurrences, often upon the slightest grounds. Were it my 
province, I could illustrate by the progress of the symptoms the pri- 
mary source of the mental derangements, but whether my views are 
admitted or not, the fact is established, that regular alvine discharges 
are of the utmost importance. 

In many cases Rhubarb will be found amply sufficient for this 
purpose, and I have been assured by a gentleman of great respecta- 
bility of this city, who laboured under this disease to a distressing 
degree, that nothing he had ever tried, afforded him more relief than 
discharges by the bowels, procured by taking small doses of Rhubarb. 

Lord Byron mentions it of himself, that when a fit of the blue 
devils was impending over him, a spoonful or two of Epsom salts, 
always restored his spirits more quickly than the finest wines, and 
others have confirmed the truth of the remark by their practice. 

In Dysentery the utility of cathartics is acknowledged, and Rhu- 
barb by its mildness, is well calculated for the purpose of evacuating 



■'..''..'. cxliv. 

the intestinal canal. It should be given in large doses and combined 
with calomel. The formula which may be employed is x. grains of 
Calomel and xx. of Rhubarb. In the more advanced stages of this 
disease the following compound may be used with advantage. 

R. Pulv. Rhei, xxx .grs. ; Pulv. Ipecac, x. grs. , Gum Opii. iv. grs. ; 
Syrup, q. s. ; ft. Pil; x. u. q. s. h. 

This formula will be found ample in allaying the uneasiness, ten- 
esmus, and griping which are so distressing. 

In Diarrhaea, cathartic medicines become necessary to remove the 
crudities which have passed into the bowels. Rhubarb is much em- 
ployed for this purpose, and is particularly well adapted, from the 
peculiarities which exist in its composition, uniting an astringent 
with a cathartic property, the former quality becoming apparent 
when the latter has ceased. On this account when evacuations are 
•required, as most frequently occurs in the early stages of disease, 
Rhubarb is considered the most proper article to be employed. After 
the bowels have been evacuated, the same formula as advised in 
Dysentery may be resorted to. 

The operation of Rhubarb, like that of Jalap, is quickened by the 
addition of neutral salts and calomel, the purgative powers of which, 
it also reciprocally augments, so that a compound formed of smaller 
portions of Rhubarb and a neutral salt or Calomel, acts with more 
certainty, and quicker than large doses of either taken separately. 

In the diseases of Children, Rhubarb is much employed — Com- 
bined with magnesia, in equal proportions, it forms a very common 
cathartic in their bowel complaints and other intestinal derangements. 
■Combined with the alkalies, as soda or potash, it undergoes a change 
of colour, becoming red, and a very useful preparation is formed in 
the same diseases. It is particular^ useful in those derangements 
which follow teething, when the bowels perform their functions feebly 
— when the passages are of a green colour, and the dejections are 
slimy and curd^^d. In these cases the compound exerts a gentle ca- 
thartic action, neutralises acidity, and exercises a tonic operation. 
The formula is as follows — 

#. Carbon. Pot. gr. xii to 3i. ; Rhei, 3i to ^ss. ; water, ?ii. one to 
two tea-spoonsfuls every two hours, according to the age of the child, 
pro re nata. 

In the treatment of these affections Rhubarb has been employed in 
a variety of ways, and every nurse professing to treat the diseases of 
children, has some favourite mode of preparing this article. They 
are generally hurtful by being combined with heating articles, with 
a view to dislorlge wind, or some other fancied effect which is to be 
produced. The formula I have given, will be sufficient for most 
cases, and where something more stomachic is required, recourse may 
be had to the Tincture. It is prepared after the manner to be seen in 
the Dispensatories. 

Rhubarb tea, prepared in the following manner — 



cxlv. 

#. Powd. Rhub., 3ii. ; Fennel Seed, 311. ; water, 1 pint, boil until 1-3 
is dissipated — the dose 3ss to ?ss, two or three times a day for several 
days. 

This is a valuable article in the early diseases of children, especially 
in colic, which occurs in the first three months. In this the child 
suffers night and day, and this preparation succeeds after anodynes 
have been administered in vain. • 

Officinal Preparations. — Ext. Rhai Pracip. — Mr. Carpenter, a Che- 
mist, in Philadelphia, has prepared an extract by precipitation. The 
specimen I present to you has been so obtained and in this form fur- 
nishes, in a concentrated state the properties of Rhubarb, separated 
from the ligneous and mucous portions, and bears a similar relation to 
the crude substance that Quinine does to the Peruvian bark. It is of 
a brownish red color, possessing a slightly styptic, pungent taste, solu- 
ble in water, and its odour that of the native Rhubarb. The pro- 
cess for preparing this article is tedious, and I do not think would be 
recollected by you if detailed, I shall therefore refer you to the 12th 
volume of the Philadelphia Journal of the Medical and Physical 
Sciences. 

Sulphate of Rhubarb or Rhabarbarine. — This chemical principle 
discovered by M. PfafF, and prepared by M. Nani, a distinguished 
Chemist of Milan, has been obtained from the Rheum Palma- 
tum. M. Nani has described the process by which this article may 
be obtained in the Bibliotique Univer, February, 1823. He speaks 
of it as being active in doses of a few grains, and to possess 
advantages over Rhubarb, from the circumstance of its possessing 
uniform strength, while the different kinds of Rhubarb have qualities 
so very various, that in many cases the ordinary doses are not uniform. 
The high terms in which this article was spoken of, induced Car- 
penter to undertake its preparation, agreeably to the formula of Nani, 
and upon repeated trials by several physicians it was found by no 
means entitled to the commendations bestowed upon it, it being in 
short a very feeble substance, requiring to be given in a larger dose 
than the precipitated extract above described. 1 

That it was not owing to any imperfection in the preparation was 
proved by a similar one from the factory of Pelletier being equally 
as feeble. In short, Rhabarbarine has more the appearance of an 
extract than any of the vegetable alkaloids. It is solid, dark brown, 
opaque, possessing the odour of Rhubarb, and a taste slightly nau- 
seous and bitter, it is deliquescent and very soluble in ether and 
alcohol. As the process for manufacturing the Rhabarbarine is ex- 
pensive and the products small, it is important that its true principles 
should be known. These are the most recent and important of the 
chemical preparations of that article. 

Other preparations. — Rhubarb readily yields its virtues to water, 

proof spirits, and to wine, on which account the officinal preparations 

of this article are greatly multiplied. The most valuable of these 

may be seen in Chapman's Therapeutics, to which I would refer you. 

19 



cxlvi. 

All the Tinctures of Rhubarb are purgative and stomachic, but 
they are not generally used for the first of these purposes, on account 
of the strength of the menstruum, and are therefore more usually em- 
ployed as adjuncts to saline purgatives, for giving them warmth, or 
to ^stomachic infusions in dyspepsia, flatulent colic, diarrhsea, the 
costiveness of old people, and of cold phlegmatic habits. 

Dose of the powdered root from 3i. to 3!. 

From 3i. to jss, opens the bowels freely, and from vj. to x. grains 
may be given for a dose when its stomachic properties are required. 

Rhubarb is often recommended to be toasted with a gentle heat, until 
it becomes friable, with a view to improve its astringency. This 
however is not effected, and its purgative property is destroyed. 

Family Liliacece — Aloe Perfoliata— Aloes. — The next article of 
which I shall treat is aloes. This is the inspissated juice of the Aloe 
Perfoliata, a native of Africa, but which is also cultivated in America, 
Asia and Europe. 

A tract of country about fifty miles from the Cape of Good Hope 
produces in great abundance the Aloe plant, and from this place 
much of the Aloes of the shops, sold under the name of Socotorine 
Aloes, is now imported. 

The plant is also carefully cultivated in Jamaica and Barbadoes. 

There are three varieties of the Aloes, viz. the Socotorine, the He- 
patic, or Barbadoes, and the Caballine or Horse Aloes. 

The Socotorine so called from being formerly brought from the 
Island of Socotoria, at the mouth of the Red Sea, is the purest and 
best, and was the only one used in medicine. 

It is of a glossy surface, clear and in some degree pellucid in the 
lump, of a yellowish red colour, with a purplish cast, and when re- 
duced to powder of a golden colour. Its taste is extremely bitter, ac- 
companied with an aromatic flavour, and the smell not unpleasant. 

The second species, the Hepatic or Barbadoes, is brought from the 
Island of Barbadoes, in the West Indies, and from the East Indies. 
It is in larger masses^ of a light colour, has an odour much stronger 
and more unpleasant than the former, and a taste intensely bitter and 
nauseous. 

The third, or Caballine, is distinguished from both by its strong 
smell. In other respects it agrees very much with the Hepatic, and 
is not unfrequently sold in its place. 

The three kinds I have mentioned, differ in being the inspissated 
juice of different species of the Aloe plant. 

Description of the Plant. 

Root perennial, strong, and fibrous. 

Leaves numerous, narrow, tapering, thick or fleshy, succulent, and 
beset at the edges, with spiny teeth. 

The flower stem rises to the height of 3 or 4 feet, is smooth, erect, 
beset, towards the top, with bracteal scales. 

The flowers are produced in spikes of a purplish or reddish colour, 



cxlvii. 

Corolla monopetalous, and cut into 6 narrow leaves which separate 
at the mouth. 

Filaments are six. 

The extract is prepared in the following manner from the plant 
The largest and most succulent leaves are cut off close to the stalk 
— they are immediately put into tubs, and disposed one by the side of 
the other in an upright position, that all the loose liquor may ooze 
out at the wound. When this is thought to be wholly discharged, 
the leaves are taken out one, by one, passed through the hand to clear 
off any part of the juice that may yet adhere or stick in the less open 
veins — the liquor is then put into flat-bottomed vessels, and dried 
gradually in the sun, until it acquires a proper consistency. 

Chemical analysis. — This has been effected by Bouillon Lagrange, 
and others, who have discovered in this substance an extractive prin- 
ciple in a considerable quantity, which by some is termed a gum, and 
a resinous matter. 

The former is intensely bitter, and possesses a faint odour, resem- 
bling in some degree that of Saffron, and the cathartic property re- 
sides chiefly in this substance — the pure resin having little or no 
purgative virtue. 

Medical Uses. — Aloes is an article which has long been known in 
the Materia Medica, and frequent mention is made of it by the more 
ancient \\ riters. By them it was held in much estimation, and there 
are few articles which have been combined in a greater variety of 
forms, or the different preparations of which have been more nume- 
rous. These, at the present time, have passed into disrepute, and the 
article meets with but few of those strong advocates, who were often 
extravagant in their commendations. 

Given in doses from 12 to 20 grains, it makes a strong impression 
upon the alimentary canal, and often excites severe and frequently 
repeated colicy pains, very fluid dejections furnished by the exhalents, 
and the intestinal secretions, which this substance promotes. 

Its action is principally upon the large intestines, and a feeling of 
warmth is felt in the fundament after each passage. 

Taken in a dose of from 2 to 6 grains, the purgative operation of 
Aloes does not produce the same symptoms, but its irritating opera- 
tion acts alwaj^s in an obvious manner upon the surface of the intes- 
tines. It occasions, commonly 8 or 10 hours after it has been taken, 
one or more passages. If its use is continued for some days there is 
soon experienced the same warmth, and even burning in the infe- 
rior part of the rectum. It is upon this portion of the alimentary 
canal that Aloes has its action directed, — that it excites irritation, 
which is often considerable, and establishes a centre, if I may so say, 
towards which the fluids are directed. The purgative property of 
Aloes would alone render it useful in medicine. But there are ad- 
vantages connected with the operation of this article, which proceed 
less from this quality, than from the property which it possesses of 
irritating the interior of the rectum, and of bringing to this part an 



* cxlviii. 

afflux of fluids. It is this derivative or revulsive power which de- 
serves attention in the diseases of the head, chest, and of the organs 
situated in the upper region of the abdomen. To obtain this opera- 
tion of Aloes, it is necessary to give it in small doses, from 1 grain 
to 6 grains, and to administer it morning and evening for some days. 
The following' formula will be found applicable to various purposes. 

#. Powdered Aloes ; Powdered Rhub. ; Blue pill mass — each equal 
parts — made into pills of a convenient size, two of the pills to be 
taken at bed-time, and another. in the morning. 

Thus given it opens the bowels, and evacuates their contents with- 
out any uneasiness or inconvenience to the patient. In pains and 
heaviness of the head, in habitual giddiness and dulness of the men- 
tal faculties depending upon this cause, it affords much relief, and 
if it does not dissipate these affections, it at least renders them 
more moderate. 

After an attack of Apoplexy, or other diseases in which the 
functions of the brain are injured, the sensibility of the system is im- 
paired, and the intestinal canal falls into a state of inactivity, the 
bowels are constipated, Aloes combined as above mentioned is useful 
in stimulating the larger intestines into action, and in obtaining alvine 
evacuations. — Barbicr, Traite Elemen. 

In various affections of the abdominal viscera, connected either 
with derangements of their secretions, or enlarged and diseased struc- 
ture, it is also valuable, not only from the moderate evacuations 
it excites, and which can be continued for days and weeks, but from 
its alterative operation. 

In uterine obstructions Aloes has been much recommended. From 
its tendency to act upon the rectum, it creates a determination of 
blood to the pelvic viscera, and in this manner operates in languid 
and phlegmatic habits in exciting a renewed discharge of the cata- 
menia. It becomes useful only when the system is in a debilitated 
state, and where there is inaction of the uterine organ. It is seldom 
used alone in this case, but combined with the Sulphat of Iron. Myrrh, 
and other articles, as in the combination called Hooper's Pills. 

We may derive an argument in favour of the importance of this 
medicinal substance from this circumstance, that the compounds in 
which it entered in a large proportion, have enjoyed a great deal of 
celebrity. They are the Elixir of Long life — the Sacred Tincture — 
the elixir proprietatis — the pilulee angelica?, &c. The titles of 
these medicines excite some derision at the present time, but they 
also prove the value which was attached to these formulae, inasmuch 
as they were employed in the general practice of physicians. 

Aloes from the smallness of its bulk, and its activity, is very com- 
monly employed in the formation of cathartic pills, and it constitutes 
the basis of most of the empirical medicines which are sold for this 
purpose, and as anti-bilious pills — for instance, Anderson's, Lee's, 
Hooper's, Dixon's, &c. &c, and its activity is doubtless much im- 



cxlix. 

proved by the combinations which are formed. See the different 
formulae for these pills. 

As patients sometimes prefer a pill, to other modes of administering 
medicines, the following formula you will find very useful and suffi- 
ciently active. 

#. Powdered Aloes, p. ; Powdered Gamboge, 3ii. ;• Tart. Ant. gr. 
iv. ; simp. Syr. q. s. mix and divide into xxiv. pills. Three of these 
pills are to be taken at bed-time, and two in the morning, if the first 
do not operate. 

As a remedy for Ascarides, $i. of Aloes dissolved in a pint of 
water or milk, used as an enema, is very useful and deserving your 
attention — but more of this when we come to the consideration of 
Anthelmintics. 

Notwithstandsng what has been said in favor of the use of this 
medicine, it has been objected to, from its supposed tendency to pro- 
duce haemorrhoidal affections. To this, however, I cannot subscribe 
altogether, as it is more probable that this complaint has originated 
in the costive habit which has generally existed some time before it 
is attended to, than to any action exerted upon the rectum. I have 
known a number of persons who have made use of Aloetic prepara- 
tions for a long time, without these effects being experienced, and 
should conceive that where it does take place, the pre-disposition must 
have existed in a considerable degree. When the disease exists, it 
•would be improper to resort to it, as from its known operation upon 
the rectum, it may add much to the irritation. 

Aloes ought not to be administered during the menstrual discharge, 
nor in those cases in which there is much uterine irritation, and a ten- 
dency to discharges from the uterus, either more frequently, or in 
larger quantity than is natural. 

Officinal preparations. — These have been very numerous, but at 
present very few are retained. The most important is the Tinct. of 
Aloes and Myrrh. The comp. decoction of Aloes. Pills of Aloes 
and Myrrh. 

The dose is from 6 to 16 grains, but if taken daily it should not 
exceed 6 grains, as in larger doses, when the use of the medicine is 
continued some days, it is apt to produce symptoms of tenesmus. 



Family Guttifera* — Gambogia, or Gamboge. — This is the con- 
crete, gummy, resinous juice of a tree growing wild in Cambogia, 
Ceylon, Siam, and Cochin China, and called by botanists Stalagmitis 
Cambogioides. The juice is collected in drops as it falls from the 
leaf-stalks, and young shoots, when they are broken from the tree, or 
by deep incisions in the bark. It is afterwards inspissated by the heat 
of the sun and moulded into' cakes or rolls. It is of a deep yellow 
colour inclining to an orange, has no smell, and very little taste, but 
after remaining some time in the mouth, gives a slight impression of 

* From gutta a drop, and fero I produce. 



ci; 

acrimony. It is readily dissolved in water, alcohol, and sulphuric 
ether, and affords one of the best examples of what is called a gum 
resin. According to the experiments of of M. Bracannot, it is com- 
posed of 20 parts of gum, and 80 of resin. 

Medical uses. — Gamboge is a very powerful cathartic and operates 
too very often as an emetic. Given in a large dose, as from 10 to 24 
grains, it exercises upon the mucous membrane an impression strongly 
irritating. The irritating action of this substance upon the mucous 
membrane is often extended to the muscular coat of the intestines, 
giving rise to undue, and severe contractions of the bundles of fibres 
which compose it, thus causing what are commonly called colicy 
pains. 

Gamboge in its passage through the stomach often distresses this 
organ, from whence proceeds the nausea and vomiting which accom- 
pany its use. In a more moderate dose these effects are not so strong- 
ly exhibited. 

In the administration of this article, where we entertain fears of 
its too irritating operation, it is very easy to unite with it, a powder 
of a softening or tempering nature, as the roots of mallows or liquor- 
ice, cream of Tartar, or Gum Arabic. Separating the particles of 
the Gamboge from each other, these substances act as correctives, 
and prevent an impression from being made upon the digestive organs, 
too great or too long continued. 

From the active cathartic properties of this article, it has been 
much employed in fevers. It was much esteemed by the late Dr. 
Rush, and by him recommended in the treatment of Yellow Fever, 
with the view of bringing on an artificial cholera morbus. He con- 
sidered this disease to partake of the character of a bilious affection, 
and on this principle the practice mentioned was established. It is 
now distinctly understood to be an inflammatory affection of the 
stomach and intestines, for which the less drastic cathartics are 
better adapted. It is therefore very properly abandoned in most of 
these cases. 

In Dropsy, it has also been much used, combined with cream of 
Tartar, or Jalap ; and in this manner it produces very copious alvine 
discharges. But it is too violent for the generality of these cases, 
which will not support the excessive and debilitating discharges 
produced by this medicine. 

A very good cathartic in the advanced stages of this disease, is 
formed by dissolving this article in Sulphuric Ether, — its stimulus 
supporting the system under the rapid depletion which takes place by 
the bowels. 

From its pecularly drastic effects, Gamboge has been much ex- 
tolled as a remedy for worms, its operation bein«v supposed sufficient 
to occasion their expulsion, or to remove from the intestinal canal the 
mucous which it contains, and which forms a nidus for their pro- 
duction. 

It is a very useful practice to administer some anthelmintic medicine 



cli. 

before recourse is had to this purgative. The remedy of Madame 
NoufTer against the Taenia, furnishes us with a very useful article. 

Giving 3iii. of this medicine, or the male fern in powder, and a 
few hours after, when the worms have experienced its deleterious in- 
fluence, a bolus, in which Gamboge is tile chief ingredient, will be 
found very efficacious. — Bar bier. 

It is easy to perceive the advantages which will attend this prac- 
tice, since in addition to the effects which follow a drastic cathartic 
upon the worm, we have added the influence which the fern itself is 
capable of producing. The Tape worm, in speaking of this article, 
is selected, as it is confessedly the most difficult to remove — with 
the other species, our success may be more conspicuous, as the 
milder cathartics are adapted to every purpose. 

The usual dose of Gamboge is from h. grains to xii. and it is com- 
monly given in the form of pills. 

Gamboge, as well as Aloes, enters largely in the formation of ca- 
thartic or anti-bilious pills, as they are called. The two articles mod- 
ify the action of each other, and hence they are generally combined. 
When speaking of Aloes, I gave you a cathartic formula ; a very good 
one is the following — 

fy. Gamboge — Aloes — Calomel each p. m. and divide into pills lx. 
ii. to iv. a dose. 

The compound pills of Gamboge, which are often a convenient 
purgative, are prepared in the following manner — 

#. Gamboge powdered ; Aloes powdered ; Cinnamon, of each ji. ; 
hard soap. 3H., mix the powders, then having added the soap, beat the 
whole together until they are thoroughly incorporated. 

The dose is v. grains to 3i. 



Family Cucurbitacece* — Cucumis Colocynthis — Called also Colo- 
quintida, and Bitter Cucumber — is a plant of the gourd species, 
growing in Turkey. 

Description of the Plant. 

Root annual. 

Stems slender, trailing, scabrous, with short hairs. 

Leaves petiolated, deeply and obtusely sinuated, green above, 
whitish, and clothed with short hairs underneath. 

Flowers small, yellow, axillary, solitary. 

Fruit, which furnishes the medicine, is of the size of an orange, di- 
vided into cells, abounding with pulpy matter, separated every where 
by cellular membrane, and including many oval compressed seeds. 
The spongy membranous part of the fruit is directed for medicinal 
purposes, the seeds being comparatively inert. To the taste it is 
nauseous, acrid, and intensely bitter. 

Colocynth is a very active cathartic, and as such was well known 
to the Greek and Arabian physicians. It was frequently employed by 

* From cucurbita, a gourd. 



• clii. 

them in different diseases, though not without an apprehension of 
danger from the violence of its effects, of which instances are related. 
To these I might add another, in which from the use of this article 
the most distressing effects were produced. These were severe grip- 
ing and rending pains in the abdomen, particularly referred to the 
region of the epigastrium, with. a sense of great internal heat, cold- 
ness of the feet and hands, and skin generally. To these were added 
severe muscular contractions of the hands and fingers, insomuch that 
they could not be employed. In short, an enteritis of the most violent 
character was produced, which only yielded to free V. S. warm bath, 
warm applications, anodynes, the oily preparations, &c. I must 
therefore caution you against using it in this state. 

The preparation used, was formed by infusing one of the Cu- 
cumbers in a pint of spirits — the dose 3ii. to fss The first dose not 
operating, a second was taken soon after, and with the effects de- 
scribed. 

The diseases in which this article is recommended are, Mania, and 
Melancholia, in both of which very powerful medicines are required 
to rouse the sensibilities of the system, and it was in these cases that 
the ancients recommended it. It is used in various other affections 
of the brain, as in coma, and apoplexy, and from the powerful im- 
pression which it makes upon the intestinal canal, it no doubt operates 
favourably in relieving the undue determinations to this organ. 

Colocynth, I would state, should never be given alone, but in the 
form of extract, with other articles, and in this manner only would I 
recommend it.* 

It is considered by Dr. J. Johnson, in combination with calomel, as 
one of the most effectual purges we possess, for evacuating the 
bowels freely, and correcting the functions of the biliary system. 
The formula he recommends is as follows — 

#. Ext. Colocynth C. 3L ; Proto chloride Mercury, xv. grains ; 
Tart. Antimony, i. grain; 01 Carui, gtt. v., make into a mass, and 
divide into xxiv. pills. The dose is 1, 2, or 3 every night. 

Another formula for the same purpose, and in all those cases where 
with the evacuant, we wish the alterative operation of cathartics, is as 
follows — 

#. Ext. Colocynth Comp. 3iv. ; Ext. Hyosciamus, 3SS. ; Blue 
Mass, 3i. m. and divide into xxx. pills, — ij. to be taken at bed-time. 

Many attempts, have been made to correct the virulence of Colo- 
cynth, by acids, astringents, &c, but these have not succeeded. The 
best method of abating its activity, without diminishing its purgative 
virtue, seems to be, by triturating it with gummy farinaceous sub- 
stances, as the oily seeds, which without making any alteration in 
the Colocynth itself, prevents its resinous particles from cohering to 
the surface of the bowels, so as not to irritate or inflame them. My 

* In combination with other cathar'ics, it loses much of its violence, but re- 
tains its purgative energy. — Wood «$• Bache. 



cliii. 

advice would be not to employ it, except as I have mentioned in the 
form of extract. 

The dose of Colocynth in substance, is from 4 to 6 grains, and of 
the compound extract much the same. 

The compound extract is prepared by digesting in proof spirit, 
Colocynth, Aloes, Scammony, and cardamom seeds, and afterwards 
evaporating the tincture to the proper consistence. This is a very 
certain and powerful purgative, and generally operates without much 
griping or inconvenience. 

Momordica Elaterium — Wild, or Squirting Cucumber. — This is 
the Cucumis Agrestis of some, and the Momordica Elaterium of 
other botanists. 

Description of the Plant. 

It is rank, rough, spreading, hairy, with round thick branches, 
destitute of tendrils. 

Leaves, heart-shaped, rough. 

Flowers, dull yellow. 

Fruit, pendulous, eliptical, blunt at each end, two inches long, 
green, rough, with innumerable small bristles. 

The plant is nearly allied to the cucumber and melon, and the 
fruit is the part used. When ripe, the fruit upon being touched 
bursts open with great force, and throws its contents to a considera- 
ble distance, hence the name Squirting Cucumber. It is a native of 
the South of Europe, and flowers in June and July. All parts of 
the plant are bitter and strongly purgative, but the dried acrid juice, 
or fecula of the fruit, known in the shops by the name Elaterium, 
is the only part now medicinally employed. The method of prepar- 
ing it is the following — 

The ripe wild cucumbers are cut up, and the juice pressed through 
a fine sieve, into a glass vessel. This is then set by to settle, until 
the thicker part has subsided. The thinner is poured off, and the 
thicker which remains, is filtered, covered with a linen cloth, and 
dried with a gentle heat. It differs in power according to the care 
taken in the preparation — for it sometimes happens, that the juice 
contains some portions of the fruit, which is inert, and which will 
lessen its activity. • 

From certain experiments of Dr.Clutterbuck, it appears, that the 
quantity of active matter contained in the fruit, is so extremely 
small, that only six grains were procured from forty cucumbers. 
The active principle is of a resinous nature,, and so heavy as to sink 
in water. To this the name Elatin is given. 

Elaterium is a very powerful cathartic, and is classed among the 
most active of the Materia Medica. It ought therefore to be ad- 
ministered with great caution, and only when the milder preparations 
have failed. 

It was much used by the ancients in cases of Dropsy, and by sub- 
sequent writers it has been highly commended. Its good effects in 
20 

■•JT 
I 



cliv. 

these cases, depends not only in increasing the peristaltic motion of 
the intestines, but in augmenting the whole of the enteric secretions 
— so that the alvine discharges, resulting from the operation, far ex- 
ceed in quantity those which are produced by any known purgative. 
Such is the powerful influence which this medicine exerts on the 
first passages, that doses from the £ of a grain, to one grain, taken 
night and morning, will induce and sustain a cathartic action, that 
will remove from the system, through the intestines, from two to four 
quarts of fluid, in the 24 hours. 

Elaterium does not produce its full effects as a Hydragogue, until 
it has been taken for several days, when its specific or peculiar action 
becomes established, and will continue uninterruptedly, as long as 
may be judged right to persist in its use. Acting as it does thus 
powerfully in evacuating the effused fluids in the cavities of the body, 
it seems to exert no action upon the kidneys. Its cathartic operation 
is so intense and direct, as almost necessarily to confine its undivided 
power to that sphere of action. 

In Hydrothorax particularly, it has been recommended by Dr. 
Ferriar. Its powers, he says, in removing serous accumulations in 
the cavities of the body, surpass those of any other medicine ; and 
the astonishing relief it affords in the dyspnoea occasioned by Hydro- 
thorax, or ascites, even in persons of the most advanced age, must 
place it in the first class of Hydragogues. 

The sensible effects of Elaterium are severe and constant nausea, 
frequent stools, and in considerable doses vomiting. It does not uni- 
formly increase the urine. Dr. Ferriar relates 15 or 20 cases in which 
this article was employed — in most of them, cures were effected, and 
in all great relief was afforded. It is really consolatory to find such 
testimony in favour of this article, in a disease so distressing, and usu- 
ally fatal — but I regret that in my trials with it, I cannot confirm the 
above statement. I have employed it in two cases, but with no per- 
manent advantage. The dose to begin with, is from 1-4 to 1-2 a 
grain in the morning, which may gradually be increased to 6 grains. 

It has been suggested, that this medicine may prove an efficacious 
alterative remedy in obstinate diseases of long standing, but with 
what success it may be employed, has not yet been ascertained. 



Carbo higni — Charcoal. — Is the carbonaceous part of vegetable 
substances, obtained by exposing them to heat, till the volatile parts 
are dissipated, and excluding the air sufficiently to prevent their entire 
combustion. This article has for some time been known in the Ma- 
teria Medica, but for various reasons has not been held in the esti- 
mation which it probably deserves. Its properties are various. As a 
cathartic it has been employed by several physicians, but its virtues 
in this respect, have been more particularly considered by Dr. Daniell 
of Savannah, and by him spoken of in high terms, in cases where 
medicines of this class are required, and with particular good effects 
in obstinate constipation. It, is given in these cases in very large 



civ. s • •*. • 

doses, a table-spoonful every hour or two. It has this particular 
good quality, that it will remain readily on the stomach, and in some 
instances seems calculated to allay irritability of this organ. For 
this purpose it has been employed, and has been spoken of very fa- 
vourably, and particularly in that irritable state which attends the 
concluding stages of Yellow Fever. 

It has been much used of late, in derangements of the digestive 
system, and much relief has been afforded by its use. Persons, in 
these diseases, who are distressed with head-aches, sore mouth, acid 
eructations, confined bowels, &c. have been much relieved. These 
complaints .are of frequent occurrence with delicate females, who 
from feebleness of constitution, and sedentary habits, are afflicted 
with the above symptoms. A tea-spoonful of finely levigated char- 
coal, taken 2 or 3 times a day, in water or milk, I have found very 
beneficial, exerting the very favorable influence of removing these 
symptoms and keeping the bowels regular. 

Mineral Cathartics. 

Having completed the consideration of the Vegetable Cathartics, 
I shall next proceed to those derived from the Mineral Kingdom. 
These are but few in number, and the most important is the 

Proto Chloride of Mercury, or Calomel. — It is also known by the 
names Sub Muriate of Mercury, Mercurius Dulcis, Aquila Alba, &c. 

It is prepared by triturating together in a marble mortar, Perchlor- 
ide of Mercury, and purified quicksilver. This is placed in a florence 
flask, or other vessel, sublimed with the heat of a sand bath, and 
washed with distilled water. The object of washing it, is to separate 
any portion of the Perchloride of Mercury or Corrosive Sublimate 
which it may contain. When first sublimed it is of a yellowish 
white colour, which deepens upon exposure to light. To improve its 
colour, and purify it further, it is again sublimed — reduced to powder, 
and again washed with distilled water. 

It is without taste, or smell, and is nearly insoluble. Lime water 
and the alkalies decompose it, by abstracting a portion of chlorine 
forming a black, or protoxide of Mercury. 

Medical Uses. — Calomel is more generally used, and is adapted to 
a greater variety of cases, than all the other preparations of Mercury. 
It is unquestionably one of the most valuable articles of the Materia 
Medica. Under different forms of administration, it is Emetic, Ca- 
thartic, Sialagogue, Alterative, Expectorant, and Anthelmintic. 

It is, however, more particularly as a cathartic, that I am to con- 
sider it in this place, and there is hardly a case, in which it may not 
be given alone, or in combination, so as to meet the several indications. 
It has too, the singular property of imparting force to the mild, and 
moderating the severity of the drastic medicines. 

It commences its operation higher in the alimentary canal, than 
most other cathartics, and is well calculated by determining down- 
wards, to relieve the stomach, and to deplete the liver and the other 



. • clvi. 

chylopoietic viscera. Hence its value in Fevers, particularly in 
those called Bilious, when the secretion is greatly increased and apt 
to accumulate in the upper portion of the intestines, producing great 
anxiety, languor, and oppression. Calomel, therefore, by commenc- 
ing its operation in the upper portion of the intestines, is well calcu- 
lated to relieve these symptoms, 

In the Bilious and other fevers of our climate, it is useful, not only 
by its cathartic properties, but by its disposition to correct the secre- 
tions of the liver, increasing them when deficient, and lessening them 
when in excess. It has too the valuable property of promoting the 
operation of other cathartic medicines, without exciting any addi- 
tional irritation, or rendering them liable to act with violence. It is, 
therefore, combined with them with advantage, and greater benefits 
are derived, than from employing single medicines. 

Combined with Emetics, particularly Ipecacuanha, it renders their 
operation milder and more effectual. 

No cathartic is more easy of exhibition. From its small bulk, and 
its insipidity, it may be administered in many cases, in which other ca- 
thartics could not readily be employed. In irritable conditions of the 
stomach, when others would be rejected, this may be exhibited with 
the utmost advantage. 

In the diseases of children it is highly useful, as it may easily be 
disguised, and in addition to the smallness of the dose, operates mild' 
ly, and with little or no danger of salivation. Dr. Chapman, in 
speaking of the use of Calomel in the diseases of children, is con- 
vinced, that its operation is milder on them, than on adults. 

When long continued in diseases, it will salivate, and this whether 
it purges or not. 

It is a common opinion, that to produce salivation its purgative ef- 
fects must be restrained. This, in many cases, is correct, for saliva- 
tion is retarded by the mercury's passing off by the bowels, — but it 
sometimes happens that patients are most easily salivated, whose 
bowels are most susceptible of its purgative operation. 

The best rules that I can lay down with a view to prevent saliva- 
tion are, 

1. To avoid giving calomel in large doses on two successive days 
without employing some other medicine, in order to remove it from 
the system. 

2. It should never be given in frequent doses, when there is but 
little diseased action, for the system seems more susceptible of sali- 
vation when the excitement is not much above the healthy state. 

3- Salivation is prevented by combining six or eight grains of Cal- 
omel, with about three times the quantity of Jalap, or some other 
vegetable cathartic. 

These rules are of some consequence. Salivation is always 
painful, and very distressing to convalescents, and I am disposed 
to think, that the good effects of Mercury may be obtained without 
being carried to this extent. But I shall consider this subject more 



clvii. 

at large hereafter. This is all that is necessary to bo said as to the 
purgative property of this medicine. Under the head of stimulants, 
I shall again speak of it as an alterative, and in this capacity it ex- 
hibits no less invaluable properties. 

The dose, as a cathartic, is from v. to x. grains. For children, 
from iii. to v. grains. 

It is somewhat remarkable, that this medicine, though given in 
larger doses, has not its purgative effect increased. The late Dr. 
May, of Maryland, took eighty grains, without more than three or 
four evacuations, and with effects not more violent than from a dose 
of twenty grains. A large dose is also less liable to be rejected. 

It should be exhibited either in pills, or mixed with some tenacious 
fluid, as syrup, or thick mucilage. From inattention to this circum- 
stance, the calomel is often lost in compound powders, by its subsiding 
to the bottom of the spoon, or other vessel employed. 

If calomel is ever violent in its operation, it is occasioned by the 
mixture of a portion of Corrosive Sublimate with it. 



Sulphur. — Is a simple combustible substance, the product of volca- 
nic countries. It is usually found combined with Iron, forming what 
is called Pyrites, and with various mineral substances. From these 
it is separated by exposure to heat, and the Sulphur which sublimes 
is collected. This is afterwards cast into moulds, and forms the roll 
Sulphur of commerce. For medicinal purposes, the sublimed Sul- 
phur only is used, and this is prepared by heating in a sand-bath an 
earthen cucurbit, charged with roll Sulphur, and collecting the va- 
pours in proper vessels placed round it, where it concretes. It is 
washed in boiling water, to remove from it any portion of acid which 
may have been formed during the process. It is of a bright yellow 
colour, but has little taste, or smell, and is very inflammable 

Medical Uses. — Taken internally it produces effects which it is 
proper to distinguish. These may be considered as they relate to the 
alimentary canal, or the general system. Given in a pretty large 
dose, as a dram or more, it is a mild and gentle cathartic, having its 
action principally exerted upon the lower parts of the alimentary 
canal. From its mildness, and from its stimulating the larger intes- 
tines chiefly to a discharge of their contents, it becomes a useful ar- 
ticle in costive habits, and with particular good effects in those af- 
flicted with haemorrhoids, as it promotes alvine discharges, without 
those straining or bearing down efforts which exert so bad an influ - 
ence on these tumors. 

It is usually combined with magnesia in equal proportions, and the 
preparation called Sulphur Praecip. or Lac Sulphuris, is preferred — a 
dram of each is sufficient for this purpose. 

Given in smaller doses, and continued at an interval of several 
hours, it exerts an influence on the general system. It renders the 
pulse more frequent, and excites the cutaneous secretion. Sulphu- 
retted-hydrogen gas, is evolved by means of the combination which 



clviii. 
• » 

it forms, with the alkaline substances in the fluids of the body. 
This gas is exhaled from the surface of the lungs and the skin. The 
urine and milk also become affected with the same It is also well 
known, that pieces of gold or silver, carried about the person, become 
of a dark or black colour. 

From its effects upon the general system, it has been employed in 
the treatment of Intermittent Fevers. 

I have frequently employed this article in Intermittent Fevers, 
given during the intermission, and I think I may say, I have uni- 
formly derived good effects. Its beneficial operation is soon mani* 
fested, and a suspension of the disease follows. Of many cases 
which have fallen under my notice, I do not recollect being unsuc- 
cessful in a single instance. In a little girl about 10 years of age, 
in whom the disease continued sometime, and refused to yield to 
emetics, frequently repeated before the paroxysm, to bark, and the 
Fowler's mineral solution, I had, recourse to Sulphur, and the disease 
was arrested. 

The dose is from ji. to 3iii. 3 or 4 times a day, mixed with a little 
milk, or taken with brandy. 

From the decided action which it exerts in the production of per- 
spiration, its use has been extended to the treatment of Chronic Rheu- 
matism Atonic Gout, Catarrhs, and other pulmonary affections, un- 
attended with acute inflammatory symptoms. In the former case it 
is usefully combined with the Gum Guaiac, and in the latter with 
the Pulvis Antimonialis, or some other diaphoretic. 

Sulphur was, at one time, much celebrated in arresting the progress 
of mercurial action, but, for this purpose, it is wholly insufficient ; 
Salivation being a disease which after it is established, will run its 
course. Its progress may be mitigated by anodynes principally, and 
perhaps the use of blisters. 

But it is principally in the treatment of the diseases of the skin, 
that this article exhibits its best effects. In these cases, its internal 
use is recommended as well as its external application to the diseased 
part. Thus in Scabies or itch, the ungt. Sulphuris, is rubbed on the 
skin, and the powder is taken in purgative doses — but, as the oint- 
ment produces a very unpleasant odour, other applications have been 
substituted, as Sulphuric acid mixed with lard, in the proportion of 
3ii. of the former to f i. of the latter, or it may be employed in the 
form of wash, with equally good effects, in the proportion of a dram 
of the acid to fviii. of water. 

Sir J. Pringle recommends the following formula, which will be 
found useful in speedily arresting the progress of the complaint. 
#. Flowers Sulphur, fi. 

Powdered Muriate of Ammon, 3L 
Lard, fiiss. m. 

This quantity serves for four inunctions, and the patient must be 
rubbed every night. Although the itch may be thus removed, by 
the above quantity, yet it will be proper to renew the application, and 



clix. 

to rub the parts most affected for sometime longer, until a second or 
third quantity be also exhausted. It is also proper to subjoin its in- 
ternal use. 

The same ointment will be found useful in Tinea Capitis. 
The usual dose of Sulphur is from one to three drams, it may be 
mixed with syrup, treacle or milk. 

Besides this mode of employing Sulphur, it has lately been intro- 
duced as an external application in the state of vapour, in several 
diseases of the skin, and in chronic and long protracted diseases. 

This mode of applying it, was introduced by Dr. Gales, of Paris, 
in the treatment of Scabies, upon the supposition that the disease had 
its origin in animalculse, and that sulphur, applied in the state of 
vapour, in which state it was not sulphur, but sulphurous acid gas, 
would be more destructive to them than its simple application, and 
of course the cure would be completed in a short time. After trying 
several plans of applying the fumes of sulphur, subjected to many 
inconveniences, they have all yielded to the more convenient and ef- 
ficacious method, of having a bath or fumigating chamber made per- 
fectly tight, into which the sulphur is introduced, after having 
been volatilized outside. The patient being seated naked within, 
has his body completely surrounded by the fumes, the head being the 
only part freed from their action. Various forms of disease have 
been found to submit very readily to this operation — these are Scabies, 
Herpetic affections of one or two years continuance, which have re- 
sisted a variety of local applications — Herpetic ulcers, connected with 
a scrofulous habit — Paralysis, universal and partial — glandular swel- 
lings — chronic rheumatism. 

The success which attended the application of the fumes of sul- 
phur, was confirmed, by a report of a committee of the most distin- 
guished physicians in Paris, and the beneficial effects which have 
been conferred upon the human species, by its introduction into camps 
and hospitals, has been truly great. The practice has been fully 
tested in this country, and the conclusions which have been formed 
have been nearly equally favorable. Upon the whole, we may con- 
sider this mode of applying sulphur, in cutaneous affections, and in 
protracted diseases, one of the happy discoveries of modern times, 
for ameliorating the amount of human suffering. The only incon- 
venience attending its use is, that the skin becomes much irritated 
after being employed several times, particularly about the scrotum 
and thighs, with a peeling off from the surface of the body, re- 
quiring its use to be discontinued, until the parts have recovered 
themselves. 

The great advantages of sulphurous vapour baths have been 
pointed out very fully by Dr. Gales of Paris, Assalini of Naples, and 
De Carro of Vienna, and their utility is so generally confessed, that 
I cannot but hope the remarks made will be recollected — not only 
should they be borne of mind, but the manner of applying them, with 
the construction of the chamber. 



clx. 

Sulphur combined with the alkalies, forming Sulphurets, is another 
very valuable article in the treatment of cutaneous diseases. Thus 
combined, it forms the substance which was called Hepar Sulphuris, 
or Liver of Sulphur. It is used as a wash in Tinea Capitis, or Scald 
Head, a complaint very common among children, and often very ob- 
stinate. It forms one of the best applications in these cases, prepared 
as follows — 

Sulphuret of Potash, 5L to 3ii. 
Water, fviii. m. 
The head is first to b'e washed well with soap and water, and the 
wash applied twice a day. I have seen some disagreeable cases 
cured speedily after this manner. 

The Sulphurets are also, employed in the formation of baths, in 
the treatment of other cutaneous diseases. In this form it is 
much esteemed at the present time, and we are indebted to Dr. Alibert 
for the important benefits which have been derived from its use. The 
practice is at present in much repute in Europe, being employed in 
the large cities of France, and in all the charitable institutions of 
that country. The bath is prepared in the follow ing manner. 

Take f ii. of the dry Sulphuret of Potash dissolved in f viii. of water. 
To this is added of the Liquid Hydrosulphuret of Potash, f viii. 
Also, of the Liquid Sulphuret of Lime, 3viii. 
Of this solution, ^ii. are sufficient to give to an ordinary bath suf- 
ficient strength, and the quantity may be increased to f iiss. . 

Thus applied, it has been found of great utility in the treatment 
of Ring worms, herpetic affections, and of other obstinate cutaneous 
diseases. 

It is not only in these cases that the baths of which I am speaking 
have been found useful — but their use has been extended to the 
treatment of Cachectic diseases in children, in enlarged and indura- 
ted conditions of the Lymphtic system, in scrofula, rheumatism, &c. 
They exhibit a local action, which is very evident when the skin 
is in a state of disease. It gives to it firmness, and softness ; developes 
its tone, and vital energies. 

Besides these forms of employing sulphur in diseases, it is of con- 
siderable efficacy in the state of Mineral Waters. Sulphurous 
waters are very abundant in many parts of our country. They are 
generally clear when taken up, and emit air bubbles, which consist 
of the Sulphuretted Hydrogen Gas. Their smell is very strong, sul- 
phurous and fetid, like that of a foul gun barrel — a taste nauseous 
and bitter, though it is remarkable that most persons soon become 
reconciled to it. These waters have been much celebrated in cuta- 
neous affections in general, and in scrofula. They are applied ex- 
ternally in the form of warm bath, as well as taken internally. 
They have also been recommended in bilious complaints, dyspepsia, 
general want of action in the alimentary canal, and calculous cases. 
They are in short useful in all those complaints that require pur- 
gatives, and at the same time are benefitted by sulphur. These 



clxi. 

waters are taken in the morning in the quantity of -a' pint and a half 
to four pints, at moderate intervals. 

The officinal preparations of Sulphur, are the Sulphur Preecipita- 
tum, Lac Sulphuris, or Milk of Sulphur. It is prepared by boiling 
fresh burnt lime and flowers of Sulphur, then filtering the liquor 
through paper, and dropping into it as much muriatic acid as may 
be sufficient to precipitate the Sulphur. Wash this repeatedly with 
water, until it becomes tasteless. 



Carbonate of Magnesia. — This article was first sold as a Panacea, 
by a canon at Rome, in the beginning of the seventeenth century, 
under the title of Magnesia Alba, or Count Palma's powder. It 
was, for several years, a celebrated secret in the possession of partic- 
ular persons, until the method of preparing it was made known by 
Lancisi, in the year 1717, and afterwards by Hoffman, in 1722. It 
is not found pure in nature, but exists abundantly, combined with 
many acids, and from these it is obtained by various processes. 

It is most usually obtained from the Bittern which remains after 
the crystallization of common salt from sea water. The Bittern is 
heated, a solution of common pearl-ash is added, carbonate of mag- 
nesia is deposited, and afterwards separated from the liquor by a linen 
strainer. In this process, the sulphat of Magnesia in the bitter 
water, is decomposed by the carbonate of Potash ; by mixing to- 
gether concentrated and hot solutions of each — a double decomposi- 
tion takes place. 

Also obtained in a large quantity from the mineral called Dolomite, 
which is a carbonate of lime and magnesia. 

Common carbonate of Magnesia, in its pulverulent state, is exces- 
sively light, and lies so loose, that a smaller weight of it will fill a 
bottle of a given size, than almost any other known powder. It con- 
sists of water, carbonic acid, and magnesia, in proportions somewhat 
varying. The quantities of each have been thus estimated. By 
calcination in a full red heat for about half an hour, both the water 
and carbonic acid are expelled, and the loss is estimated at about 
fifty-five per cent. When quite freed from water and carbonic acid, 
the magnesia that remains, is the magnesia usta, or calcined magnesia 
of the shops. 

Magnesia is an article of much utility in medicine. Its purgative 
operation depends upon its meeting with an acid in the stomach, by 
which a neutral salt is formed. When no acid exists, it is nearly 
inert. On this account it is not a very certain medicine, but it is re- 
sorted to chiefly by those who are troubled with much acidity. It is 
under these circumstances a useful antacid, and a safe and mild laxa- 
tive, in doses of one or two drachms. 

The carbonate of magnesia, in consequence of the disengagement 

of carbonic acid gas, which takes place in the stomach, is productive 

of unpleasant symptoms, as flatulency, griping, and other uneasy 

sensations, especially in weak bowels. On this account the calcined 

21 

S 



clxii. 

magnesia ia preferred, and particularly when it is administered to 
children. 

The calcined magnesia is prepared, by exposing the carbonate to 
heat for a certain time, by which the carbonic acid gas is expelled, 
and the article is in a state nearly of purity. By this process it is found 
to be equally purgative, when given in half its former dose. It is 
deprived by this process of the disagreeable qualities above mentioned, 
and acquires also new properties, which render it likely to answer 
some other important practical purposes. 

By calcination, it is not only rendered incapable of generating air 
in the stomach and bowels, but it is qualified to absorb, or render fixed, 
that which it finds there, and which is produced sometimes in too great 
quantities in the process of digestion. With children, in whom 
acidity in the first passages frequently prevails, who are often dis- 
tressed with cramps, and colicy pains, from the production of wind, 
this article is eminently useful, and for the reasons I have given 
should always be calcined, otherwise it may aggravate the symp- 
toms it was designed to relieve. From it a valuable medicine is pre- 
pared called Dalby's Carminative, which from its efficacy and 
general employment should be known to you. The formula may be 
seen in the Dispensatories, or in Paris' s Pharmacologia. 

This you will find of great utility in relieving the griping pains, 
flatulency, and uneasiness to which children are subjected at a very 
early period of life. 

Another formula of much advantage is one recommended by Dr. 
Dewees, in the colicy complaints of children. It is as follows — 
Calcined Magnesia, 3i. 
Water, f i. 

Tinct. Assafcetida, gtt. lx. 
Laudanum, gtt. xx. 

Twenty drops are a dose. If not relieved, to be repeated in an 
hour or two. This preparation is, I think, inferior to the mixture of 
carbonate of soda, or potash and rhubarb, mentioned a short time 
since. 

Magnesia is very frequently combined with rhubarb, in the treat- 
ment of Diarrhaeas and other complaints. 

Besides these diseases, it has lately been introduced in the treat- 
ment of calculous complaints, and in some cases with great benefit. 
Of its use in these diseases I shall speak on a future occasion. 

Dose for a cathartic is 3ss. to ^ii. Its most convenient vehicle is 
water or milk. 

The habitual or long continued use of Magnesia, has sometimes 
occasioned distressing symptoms from its retention in the bowels. A 
remarkable instance is related, of a person who was in the habit of 
using this substance in large quantities for a considerable time — after 
his death, it \i as found accumulated in the colon, having undergone 
little or no change by the action of the vital powers. 

Magnesia is an excellent article in cases, where the mineral acids 



clxiii. 

have been taken in a large quantity, either by accident or design. 
It combines immediately with the acid, deprives it of its acrimonious 
properties, and is converted into a saline substance by no means 
deleterious. 



NEUTRAL SALTS 

Are a class of medicines, intermediate in their operation between 
Laxatives and Purgatives. They are more powerful than the first, 
and less acrid and stimulating than the last. By their stimulus they 
excite the exhalent vessels of the Intestines to pour forth a large se- 
cretion, by which the contents of the bowels are reduced to a fluid 
consistence, and the general system depleted. From not exerting an 
action upon any particular viscus, they seem adapted only to evacu- 
ate the contents of the bowels, and to reduce the general tone of the 
system. Hence their utility in inflammation, or topical congestion ; 
and from their effects in allaying action, and reducing the heat of the 
system, they have been called cooling medicines. 

Of these the first in importance and power, is the Sulphat of Soda, 
or Glauber's Salt. 

This article is prepared from the saline residuum of several chem- 
ical processes, particularly after distilling muriatic or hydrochloric 
acid, from chloride of sodium by sulphuric acid. 

This is one of the most common and useful of the saline cathar- 
tics. It evacuates the bowels speedily, effectually, and without pain, 
heat, or inconvenience. It contains a large quantity of water of 
crystallization, from which it is separated by exposure to the air. By 
this means, it is reduced in bulk and weight, in consequence of which 
a smaller quantity will be effectual as a dose. 

The objection to this saline preparation is, that while it is more 
active, it is more nauseous than the rest. There is no method of dis- 
guising its taste — it is less disagreeable by being taken in a little 
water, but it is also less active. The activity of saline medicines 
generally, seems to depend upon their being dissolved in a large 
quantity of water. It is upon this principle we explain the action of 
many preparations, as Seidlitz powders, sea water, &c. in which the 
active ingredients are largely diluted. The unpleasant taste of this 
salt is, however, said to be much diminished by holding brandy in the 
mouth previous to taking it. The usual dose is an ounce. 

An excellent febrifuge mixture is prepared in the following manner 

fy. Glauber's Salts, fii. 
Tart. Antimony, grs. ii. 
Lemon juice or vinegar, f i. 
Water, f viii. m. f ss. to f i. every two hours until it operates. 

In this form it not only opens the bowels, but is diaphoretic. 

Sulphate of Magnesia — Is found native, and in combination with 
Gypsum. It is also prepared by evaporating the water of Mineral 
springs, as Epsom springs in England, whence its name is derived. 



clxiv. 

But it is now principally obtained from the liquor remaining after 
the crystallization of Chloride of Sodium from sea water. The 
bitter water is boiled down, until on cooling, in clear and cool weather, 
it affords the Sulphate of Magnesia in acicular crystals, in the pro- 
portion of 4 or 5 parts to 100 of common salt, obtained from the same 
water. 

This is a more pleasant medicine than the preceding. It is mild 
in its operation, and agrees better with the stomach, from its bitter- 
ness, than the other preparations. The remarks made upon dilution 
arcapplicable here. ' Dose, fi. 

Sulphate of Soda is often substituted for this salt, which it may be 
made to resemble, by stirring it quickly at the moment it is about to 
crystallize. The fraud may be detected by adding to the solution of 
the suspected salt, a little of the Carbonate of Potash — if it is Sul- 
phate of Magnesia, a precipitate of Carbonate of Magnesia will be 
formed, proportioned to the purity of the article, and Sulphate of 
Potash will remain. If Sulphate of Soda, no precipitation will take 
place. When it is necessary to aid the action of the saline medicines 
with other articles, the following preparation, known under the name 
of the black draught, may be employed. 

Sulphat Magnesia, |ss. 

Infusion Senna, C. f iss. 

Tincture Senna, ji. 

Syrup Ginger, ji., mix as a purgative draught. 



Phosphate of Soda — Is a medicine lately introduced into practice. 
It is said to be less unpleasant in its taste, and to be a good substitute 
for the other neutral salts, particularly when there is any tendency to 
nausea. As it, however, possesses no particular advantages, I need 
not dwell longer upon it. 

Preparation. — The usual process is to add Carbonate of Soda in 
excess, to the impure phosphoric acid procured from the decomposi- 
tion of bone ashes by sulphuric acid. The solution is filtered, and 
crystals are obtained by slow evaporation. 



Tartrate of Potash and Soda — Commonly called Rochelle Salt. 
It received its name from being introduced into practice by an Apoth- 
ecary at Rochelle, whose name it long bore, Sal de Signette. It is 
formed by adding Soda to a solution of the Bi Tartrate of Potash, by 
which the excess of Tartaric acid is neutralized, and a triple salt, 
Tartrate of Potash and Soda, is formed. It is less agreeable than 
the Phosphate of Soda, but more so than the Sulphate. It requires 
to be given in a larger dose. 

Sulphate of Potash. — This salt is called in medicine Sal Polychrest, 
and in the old chemical nomenclature, Vitriolated Tartar. It is formed 
by directly adding sulphuric acid 'to a solution of Potash, until the 
mixture is neither acid nor alkaline. This mixture, on evaporation, 

i 



clxv. 

• 

affords crystals which are larger, and more complete, according to 
the slowness of the evaporation. 

The taste of this salt is rather bitter, and it is not very soluble in 
water. 

Sulphat of Potash acts as a gentle asperient, in doses of 30 or 60 
grains. In the dose of 3V. or 3vi. it acts as a mild cathartic — though 
on account of its difficult solution, it is much slower than the preced- 
ing salts. It is, therefore, rarely given alone, but is employed in com- 
bination with other cathartics, the operation of which it greatly pro- 
motes. It is frequently united with Jalap, or Rhubarb, in small pro- 
portions, and a very useful and effectual cathartic is thus afforded. 

Of the other Neutral Salts, as Bi Tartrate of Potash, Nitrate of 
Potash, &c. I shall speak under other heads, where they can more 
properly be introduced. 



MINERAL WATERS. 

Having thus given a general description of the principal saline 
preparations in use, it is proper to consider several other saline com- 
binations, which though not generally employed, still require some 
attention. These are Mineral Waters, a form of exhibiting purgative 
medicines, not only useful, but agreeable. 

The first circumstance to be considered, is the small quantity of 
active ingredients contained in any given water. The smallness of 
the quantity of active ingredients, is compensated by their number. 
Many of them, as sea water, and other mineral waters, containing 
three, four, or more, different salts. The activity therefore experi- 
enced, is the result of a law formerly mentioned, that the combina- 
tion of two or more substances, of a similar nature, will produce a 
more powerful effect, than an equivalent dose of any one. 

The next circumstance to be considered, is, their extensive dilution. 
That extensive dilution is of essential service, is proved by the little 
activity of these articles, when taken in a small quantity of fluid, 
compared with the essential benefit they produce in the form of great 
dilution. 

It is true, that the force of impression on any particular part is 
thereby lessened, and dilution may therefore be carried to excess — 
but the circumstance of extent of sentient surface, acted on at once, 
will probably, in most cases, counter-balance this, and free dilution 
frequently promotes the general curative intention of mineral waters, 
as evinced in the very weak solution of a purging salt, which occurs 
in Cheltenham or other water. 

The gaseous substances which are combined in a mineral water, 
are deserving of much consideration. The precise operation of these 
subtle agents, is not made known, but the effects of a gaseous water 
are more powerful, in proportion to the suddenness of the expulsion 
of the air, and therefore to the looseness of its adhesion to the water^ 
with which it is combined. 



clxvi. 

Of the variety of Mineral Waters, I shall only speak of the most 
important, and such as are generally employed. 

Of those simply saline, the first is the Seidlitz Water. I shall in 
this enumeration, mention only those mineral waters remarkable for 
their saline impregnations, and of which imitations are made. 

Seidlitz Salt, is the product of a spring found near Seidlitz, in 
Bohemia, a country abounding in mineral waters of various descrip- 
tions. The water was long neglected by the inhabitants, on account 
of its salt bitterness, until it was brought into notice by the celebrated 
Hoffman. The taste of the water is very saline, and bitter, but not 
in the least degree acidulous or brisk. 

The particular analysis will not be interesting to you ; it will be 
sufficient to state, that a pint contains the following proportion of 
active ingredients. 

Carbonate of Lime, 944 

Selenite, 5-140 

Carbonate of Magnesia, 2-622 
Muriate of Magnesia, 4-567 

Sulphate Magnesia, 180-497-total, grs. 193-770, or 3 drachms, 
13^ grains. — Bergman. 

From this analysis, it appears to be strongly impregnated with the 
Sulphate of Magnesia, and to this it owes its bitter, saline taste, and 
purgative property. 

The identity of this salt, with that found in the Epsom spring, 
was ascertained by Hoffman, and as the Seidlitz water contains more 
of the active principle, the salt has been largely procured, by the 
usual processes of evaporation, and crystallization, and sold as the 
Seidlitz salt or powders. The effect which the water produces is in 
a high degree purgative, greater than might be supposed from the 
mere quantity of active matter. 

A pint is generally a dose, and it has this advantage over the 
milder cathartics, that it operates without griping or any uneasiness. 

This water is imitated artificially — the Seidlitz draught is com- 
posed of two different powders. One contained in a white paper, con- 
sists of 

Tartrate of Potash and Soda, or Rochelle Salt, <;ii. 
Carbonate of Soda, 3ii. 

That in the blue paper of Tartaric acid, grains xxxv. 

The contents of the white paper is dissolved in the fourth of a 
tumbler of spring water, and the blue paper in the same quantity of 
sweetened water. They are united upon being taken, and swallowed 
during the effervescence. 



Sea Water — Is the strongest in saline matter of all the natural 
waters which are used medicinally, and indeed of all the waters we 
are acquainted with, certain brine springs and salt lakes excepted. 

Sea water by analysis contains several distinct salts, which when 



1 



clxvii. 

reduced to English weights and measures, are in the following pro- 
portions. 

An English pint contains as follows. 

Chloride of Sodium, 24 i grains. 

Muriate of Magnesia, 65 

Sulphate of Magnesia, — 

Muriate of Lime, 8 

Iodine, — 

Bromine, — 

The foregoing results will vary in some degree, according to situa- 
tion, that is whether obtained near the sea coast or not, in this latter 
situation it contains less salt. 

Sea water seldom excites nausea, except to very irritable stomachs, 
or those to whom the taste is peculiarly unpalatable In the quan- 
tity of a pint, it generally proves purgative, especially when the 
stomach has not long been used to this medicine, and it is a property 
which this water possesses, in common with the other bitter saline 
waters, that it may be persevered in for a considerable time, and a 
daily increased evacuation from the bowels be produced, without 
debilitating the stomach and intestines, or impairing the digestive 
powers. 

Sea water is not only used internally in various complaints, but 
also externally in the form of baths, particularly in scrofulous af- 
fections. 

The powers of this remedy, in this disease, were brought into 
notice by Dr. Russel, and subsequent experience has confirmed the 
beneficial effects, which arise from its judicious use. When taken 
internally, it should be in such doses as will prove moderately purga- 
tive. A pint is generally sufficient, and this should be taken in the 
morning, at two doses, with an interval of half an hour between 
each. 

It is often necessary to persevere a long time in the use of sea 
water, and it is a great recommendation, that such perseverance is 
seldom productive of bad consequences to the general health. Dr. 
Russell mentions a case, in which a pint of this water has been 
taken daily for two hundred mornings, without any interruption, 
which produced a continued course of moderate purging, yet the 
appetite continued all this time perfectly good, and the health im- 
proved. 



Cheltenham Water is also saline, though it possesses chalybeate 
properties. A gallon contains the following principles, 

Sulphate of Soda and Sulphate of Magnesia, grains 480 
Chloride of Sodium, 5 

Muriate of and Carbonate of Magnesia, 25 

Selenite, 45 

Oxyd of Iron, 5 — 555 grs. 

Carbonic acid gas, a large quantity. — Father gill. 



clxviii. 

From this Analysis, it would appear to be possessed of several very 
valuable ingredients. It is decidedly saline, and the salts are for the 
most part of a purgative nature. 

It is also a chalybeate, and if the analysis be correct, it is one of 
the strongest we are acquainted with. The Iron is suspended entirely 
by the carbonic acid, of which gas the water contains about an eighth 
of its bulk. 

Cheltenham water will not keep well, without being materially 
altered, for the chalybeate part is soon lost, by the precipitation of 
the Iron, which takes place, even in the closest vessels, after a few 
days. In order to obviate these effects, and to reduce some of the 
most valuable parts of this water to a more convenient form for car- 
riage and keeping, the purgative salts are procured on the spot by 
evaporation, and by crystallizing the residuum, which is sold under 
the name of Cheltenham Salts. It is, in fact, little more than a mix- 
ture of Sulphate of Magnesia, and Sulphate of Soda, and of this, the 
Cheltenham Salts, so common in the shops of our apothecaries, con- 
sists. A moderate dose operates effectually and speedily, as a ca- 
thartic, and in common with many others of the largely diluted 
saline waters, it acts in a very gentle manner, without occasioning 
griping. 

A factitious compound is sold as a popular purgative under this 
name. It is formed by triturating together the following salts. 

Sulphate of Soda, 120 grains 

Sulphate of Magnesia, 60 

Chloride of Sodium, 10 



Sulphate of Iron, 



I do not know that as we receive the salts, whether they are ca- 
pable of fulfilling any other than the above indications. Taken from 
the spring at Cheltenham, a small town in Gloucestershire, and from 
which this salt derives its name, it is endowed with more active 
powers, and is capable of being applied to a variety of cases. To 
persons labouring under hepatic derangements from long residence in 
hot climates, and also in scorbutic affections of the skin, it is very 
efficacious. 



In our country, the principal saline mineral waters are those of 
Saratoga and Balston, in the State of New-York. From an accu- 
rate analysis they consist of the following principles. In a quart of 
the Balston spring water there is found 

Carbonic Acid Gas, 60 cubic inches 

Chloride of Sodium, 43 grains 

Muriate of Lime, 4 

Muriate of Magnesia, 2 

Carbonate of Xjime, 1 1 

Carbonate of Magnesia, 9 

Carbonate of Iron, 1 



clxix. 

Congress spring, at Saratoga, contains in the same quantity of 
water — 

Carbonic Acid Gas, 66 cubic inches 

Chloride of Sodium, 103 grains 
Hydriodate of Soda, 
Bi carbonate of Soda, 
Carbonate of Lime, 27 

Bi carbonate of Magnesia, 
Carbonate of Iron, \ 

Hydrobromate of Potash. Steel. 

Upon these ingredients it may be proper to make some remarks. 
The Carbonic Acid Gas is a very important one, that upon which 
it may be said the principal qualities of the water depend. All 
other ingredients which it contains, would be heavy and inert with- 
out the aid of this acid. Deprive the water of this principle, and 
almost all its virtues disappear. It is this which holds the Iron and 
earths in solution, gives to the water its agreeable pungent, subacid 
taste, and excites that exhilaration of spirits, which almost all per- 
sons feel who drink the water. 

The next useful article is the Chloride of Sodium, or common salt. 
It is most certainly from this salt combined with the water, in a very 
dilute state, that the purgative quality of these waters is derived. 
That a substance with which we are so familiar, and which is almost 
necessary to life, should be so powerful a purgative, as the Saratoga 
waters are known to be, would appear surprising. But combined as 
it is with other substances, it sensible, and even physical properties 
are greatly altered and improved. In consequence of its combina- 
tion with an excess of carbonic acid, daily evacuations, to a consid- 
erable extent, may be produced, without debilitating the stomach 
or intestines, but on the contrary, the health, appetite, and spirits are 
improved. 

Another important ingredient is the Iron, which though small in 
quantity, yet equals that of any other spring in Europe. The ope- 
ration of this article upon the system is familiar to you. 

From this cursory view, the observation of Dr. Cullen upon mine- 
ral waters will appear striking. They often, he says, produce cures, 
which we in vain attempt to perform by the combinations in our 
shops. 

The other salts though small in proportion, and their uses not very 
well defined, are doubtless of utility. 

From a review of what has been said, it is not surprising that before 
the analysis of these waters was effected, and their operation de- 
scribed, they were considered specifics prepared by the hand of nature 
against those formidable diseases to which mankind were liable. 
With the lights which Chemistry has lent us, we can explain their 
effects, so as to exclude any thing mysterious, though, unfortunately, 
we cannot imitate them. 

Diseases in which these waters are employed. — They are adapted 
22 



clxx. 



to all those which proceed from a disordered state of the functions 
of the alimentary canal, or' from obstructions of any of the viscera, 
particularly of the biliary organs, whether occasioned by irregularity 
in living, or the vicissitudes of climate and season.— References — 
Saunders on Mineral Waters — Bell on do. do. — Periodicals. 



ENEMATA. 

Before concluding the subject of Cathartics, it may be proper to 
make a few remarks upon Enemata or Glysters. , These, though 
humble means, are sometimes employed as substitutes for purging, 
and have been found to serve some important purposes. They are 
useful to evacuate the rectum, but principally to promote the operation 
of cathartic medicines, and in this respect their beneficial effects are 
best exhibited. When Enemata are employed as purgatives, it 
should be remembered, that they cannot pass higher up than the 
valve of the colon, and consequently they can only act upon the 
large intestines. Therefore, they can seldom entirely supply the 
place of purgatives by the mouth, which pass through, and excite 
the whole intestinal canal — but they act as topical fomentations, and 
very often induce ease and sleep, when other methods fail. 

Enemata are prepared in various ways. The most common Ene- 
ma is as follows — 

Castor Oil, f i. 
Molasses, f i. 
Warm water, 1 pint. 

To this may be added f ss. to f i. of common salt, or a pint of soap 
suds, with f ss. of common salt ; or an infusion of Senna with salt ; 
or an ounce of Antimonial wine in water ; or a solution of Tartarised. 
Antimony, 8 or 10 grains, to a pint of water. Any of these Ene- 
mata are sufficient for most purposes, and will either evacuate the 
rectum, or promote the operation of cathartic medicines. 

The instruments commonly employed for this purpose, are a large 
bag or bladder and pipe, or pewter syringe. The former is very in- 
sufficient, and should never be resorted to, but from necessity. The 
syringe, when in order, answers for ordinary purposes very well. I 
present you with an instrument extremely well adapted for the ordi- 
nary purposes, and on other occasions, when we wish to overcome 
constipation by distending the bowels with fluids. It consists of a 
small cylinder, capable of containing four ozs. of fluid, furnished 
with valves so arranged, as to admit of fluids being introduced 
through one, and discharged through the other. It is, in short, 
when applied to the purpose I am describing, upon the principle of 
the forcing pump. Besides filling the bowels with any quantity of 
fluid, it has this great advantage, that it can be employed by the pa- 
tient himself, when seated on a bench, in which an opening has been 
made, or may be introduced under the bed-clothes, and thus any ex- 
posure prevented The pipe is introduced into the rectum, and the 
end of the instrument placed in a basin of prepared fluid. 



clxxi. 

This instrument is also employed for evacuating the stomach of 
poisonous substances, and the gratifying results which have followed 
when laudanum or other substances have been taken, with a view to 
suicide, are such, that I may say, an instrument of this kind, should 
be in the possession of every physician. 

When more powerful enemata are required, Tobacco, either in in- 
fusion or smoke, should be employed. The former is prepared by 
adding 3i, of the leaves to a pint of warm water, and it is given in 
two portions. As distressing effects sometimes result from it, it is 
only to be resorted to in cases of emergency. ' I have witnessed an 
instance of the great depression produced by this substance, the pa- 
tient being reduced to the last stage of exhaustion. To obviate 
these bad consequences, Mr. Eaiie has suggested that a suppository 
of Tobacco, or a segar, be introduced up the rectum, the symptoms, 
as they become distressing, may be allayed by its removal. The 
smoke is a more safe application than the infusion. An apparatus 
has been invented for this purpose, but as it is not always at hand, 
the following contrivance is a very good substitute. Take a com- 
mon pipe, into the bowl of which tobacco is to be placed, and then 
covered over with a fold of linen, or other substance — the tobacco is 
to be previously kindled, and the pipe introduced into the rectum — a 
stream of air is directed upon the inflamed tobacco, which forces the 
smoke through the pipe into the rectum. 

It is singular, however, that cold, or even iced water, has been re- 
commended by Dr. Rush to overcome obstinate costiveness, and it is 
no less remarkable, that walking over a cold hearth bare-footed, or 
throwing water over the thighs and legs, has been productive of the 
same effect. This method has succeeded very frequently, and I have 
been informed by a very respectable practitioner of this city, that 
being called in consultation in a case of obstructed bowels, the 
method alluded to had succeeded very satisfactorily. Very large 
doses of active medicines had been exhibited, and a great deal of 
castor oil without effect. 

Such are the circumstances most worthy of attention, upon the 
subject of enemata, with a view to their cathartic operation. 

They are employed, however, for other purposes. The rectum is 
remarkable for its sympathetic connections, and with most of the 
viscera of the pelvis, this connection exists in a great and powerful 
degree. When, therefore, irritation of any of these parts is to be al- 
layed, or of the system generally, we can direct our remedies through 
this channel, with great advantage. The enemata to be considered 
are of an Anodyne nature. These instead of containing much fluid 
seldom exceed a gill, and for this obvious reason, that they are de- 
signed to be retained. Two or three times the quantity of Laudanum 
is required, when thus used, as when it is given by the mouth, and it 
is combined with a solution of starch, flax-seed tea, &c. Take 60 or 
80 drops of Laudanum, and from fss. to fi. of flax-seed tea, or solu- 
tion of starch. This to be employed and repeated as often as is ne- 
cessary. 



clxxii. 

In irritable affections of the bladder or its neck — in the painful and 
spasmodic diseases of the uterus — and in the tenesmus of dysentery, 
they are very valuable. In irritable conditions of the stomach when 
every thing taken into it is rejected, or when from peculiar idiosyn- 
crasy, anodynes cannot be given by the mouth, they are productive 
of the happiest results, and in any of these cases their beneficial 
consequences at a proper period of the complaint, should be kept in 
recollection. 

While upon this subject, I may mention a few other specific pur- 
poses, for which enemata have been employed. As vermifuges they 
have a peculiar and local use, when the worms are lodged in the 
lower intestines, particularly as very highly stimulating medicines are 
required to dislodge these troublesome animals, which if given by 
the mouth might produce a great deal of inconvenience and irritation. 
I shall speak more on this subject hereafter. 

Tobacco infusion is given by way of glyster in strangulated hernia, 
to bring on that extreme degree of faintness and relaxation, which is 
most favourable to the reduction of the hernia. 

In uterine or intestinal hemorrhage, astringent glysters, and par- 
ticularly iced water, are sometimes of powerful use in checking these 
alarming accidents. 

A solution of Assafcetida and other antispasmodics, are often re- 
sorted to in hysteria and other complaints, for which this class of 
remedies is employed. Nutritive enemata are sometimes had re- 
course to, when from obstructions in the (Esophagus, nourishment 
cannot be conveyed into the stomach. In a few days the capacity 
of the rectum is so much increased, that fluid nourishment, to a con- 
siderable extent, can be given, and if we judge from the faeces, which 
in these cases are of a good colour and consistence, digestion would 
appear to proceed regularly. But though life may be protracted by 
this means, yet, we may be assured, that no application of food to 
the inner surface of the rectum, can ever supply the absence of it in 
the stomach. For these vicarious actions of the system are always 
defective, whether arising spontaneously, or from the assistance of 
art. 

In cases of sudden collapse of the system, following fevers, or other 
cases where prompt remedies are required, and the powers of digluti- 
tion fail, there is no part of the system to which stimulants may 
more effectually be applied than to the rectum. Under these circum- 
stances enemata of turpentine, of brandy and water, half and half, 
may be employed with the greatest advantage. 

Suppositories are substances introduced into the rectum to procure 
stools. They are chiefly employed in relieving costiveness in infants, 
as well as adults. The best article is a piece of hard soap, cut into a 
cylindrical form, an inch or two in length, or a piece of paper may 
be rolled up into a point at one end, moistened with oil and introduced. 
These are commonly sufficient to excite an operation, by the irrita- 
tion they excite in the rectum, and as they supply the place of medi- 
cine, deserve some consideration. 



clxxiii. 

Suppositories are often formed of opium, or a pill of opium may 
often be employed in those diseases in which anodyne enemata have 
been recommended, either for the purpose of acting upon the diseases 
of the rectum, or of the neighboring organs. They will often be 
employed by patients, to whom the use of injections is disagreeable, 
or when from the soreness of the rectum, introducing the pipe of a 
syringe would be very painful. 

I have thus concluded whatever was necessary upon the subject of 
Cathartics. A class of medicines from which we derive more per- 
manent benefit, by which we control the irregular determinations of 
disease, and can operate more extensively upon the deranged secre- 
tions, than with any other class of the Materia Medica. They are 
indeed powerful agents, and to know when to use them with vigour, 
and when to withhold them, is only the result of a perfect knowledge 
of the article and of the disease we are treating. 



The Third Division of the articles of the Materia Medica, com- 
prehending that class of medicines which increase the natural ope- 
rations of the intestines, without exciting irritation, having been 
considered with the second, I therefore proceed to the fourth. 

Division IV. 

Embraces those means by which we destroy, or counteract, offending 
substances lodged in the alimentary canal. 

ANTHELMINTICS. 

By this term is meant such medicines as have the power of ex- 
pelling, or destroying worms, situated in any part of the intestinal 
canal. 

This includes an extensive variety of articles, which have been 
variously arranged, according to the peculiarity of their operation. 
Some of these medicines, act in the manner of a poison on these ani- 
mals, others destroy them by a mechanical action, others by exerting 
a strong cathartic operation, and others, as chemical agents, in cor- 
recting that condition of the stomach and bowels, which appears to 
favour their generation and nourishment. 

Each division has been made the foundation of an arrangement 
of this class ; but as every kind of worm has its appropriate remedy, 
I prefer following the order of Dr. Chapman, in dividing them, ac- 
cording to the worm they are best calculated to remove ; though it 
is still to be understood, that some of these articles are equally ap- 
plicable to every sort of worm, and that they may be indiscriminately 
employed. 

It is a fact, well known to physicians, that in the human body, 
there are found, occasionally, different species of worms. I shall 
treat of them as they differ in their habits, character, and structure. 



clxxiv. 

They are divided in two general divisions — the round and flat 
worms. 

Under the first division are included, 

1. The Ascaris Lumbricoicles, or the long round worm. 

2. Ascaris Vermicularis, or Oxyuris Vermicularis — the maw or 
thread worm. 

3. The Trichuris Vulgaris, or the long thread worm. 
Under the second division is considered, 

The Taenia, or Tape worm. Of this worm there are two species, 

1. The Bothriocephalus Latus.. 

2. The Taenia Solium. 

The Ascaris Lumbricoides, is of a round form, in length from ten 
to twelve inches, and its circumference equal to that of a goose quill. 

They infest the small intestines, but more frequently the course of 
the jejunum, and ileum. Sometimes they are known to ascend through 
the duodenum into the stomach, and they have been seen to creep 
out of the mouth and nostrils. It happens but rarely that they de- 
scend into the tract of the large intestines, and then, only after the 
exhibition of vermifuges, or from other causes which increase the 
peristaltic motion. They, in general, are found in considerable num- 
bers. In one instance I have known from sixty to seventy being ex- 
pelled in a few days, and have heard of two hundred in the course 
of a week. 

Their colour is at first transparent, and they appear as if they have 
been sucking water mixed with blood — this colour soon disappears, 
and they become at length of a light and opaque yellow 

They are very feeble when they are voided, and soon die, in spite 
of all attempts to keep them alive. 

This worm has been confounded by some with the common earth 
worm, the Lumbricus Terrestris. 

The sexes of the Lumbrici are distinct, and they are oviparous, 
the ovula being discovered in the mucous surrounding them in the 
intestines. 

All the intestinal worms are oviparous, and they produce a consid- 
erable number of eggs. If all these eggs came to maturity, the 
diseases from this source would be exceedingly numerous as well as 
dangerous. Fortunately, several occurrences take place, calculated 
to prevent their developement. In short, it has been remarked by 
Rosin, that it is difficult for these animals to be abundantly pro- 
duced. 

This arises from the continual action of the intestinal canal, by 
which the eggs are carried downwards, and expelled with the excre- 
tions. In addition, the different gases, with the alimentary substan- 
ces found in the intestinal canal, are often very unfavorable to them, 
and suffice frequently to prevent their development, or to effect their 
destruction. 

The uterus in this species of worm is very peculiar. It branches 
out into two large crura, which for the space of one or two inches 



clxxv. 

are continued of an uniform diameter. They then suddenly become 
diminished in size, and appear like opaque threads lying over, and 
embracing in a convoluted manner the intestinal tube in the middle. 
This convoluted apparatus is composed of very fine transparent 
membranes, which is distended with innumerable eggs. 

It is these opaque threads which are visible through the transpar- 
ent covering of the worm, and which, in common language, are 
considered as so many young worms. 

The worms of which we have" been speaking do not infest the 
human subject only. They are to be found in the hog, horse, dog, 
cat, and other domestic animals. 

2. The Ascaris Vermicularis, Ascarides, maw or thread worm, are on 
the contrary very small, being in thickness of the size of a piece of 
thread, and when full grown about half an inch in length. 

They are most commonly situated in the rectum, and when there, 
frequently pass out per anum. 

They are also met with in the coecum and colon, and have been 
found in the stomach, whence they have been called maw worm. 

In the rectum of children or adults, they are generally in consider- 
able numbers, but when in other parts their numbers are less con- 
siderable. 

When discharged, they are extremely vivacious, and it is prob- 
ably from this circumstance that the term Ascarides has been 
employed, from the Greek word Askarizein, Saltare, to leap. The 
male and female are here also distinct, and not as generally considered 
hermaphrodite. 

3. The Trichuris Vulgaris, or Trichocephalus dispar, or long thread 
worm. 

This worm is of rare occurrence, and it is only within the last 
half century, that any notice has been taken of it, or any accurate 
description drawn. Its body when full grown, equals in breadth the 
sixteenth of an inch, and in length nearly two inches. From the 
head proceeds a kind of proboscis, which the worm protrudes or 
withdraws at pleasure. 

The anterior part of the worm is small and capillary, forming two 
thirds of its length. It terminates in an acute point, where the 
mouth is situated. The posterior part swells out to a considerable 
size, and in the male is twisted round in a spiral form. In the pos- 
terior part is found the spermatic vessels convoluted, or folded back 
upon themselves, and which terminate at the extremity of the tail. 
In the male is a small transparent tube, or penis, and in the female is 
a kind of vagina. 

These worms have been found in the intestinum rectum, in the in- 
ferior part of the ileum, also in the jejunum, mixed with their con- 
tents. 

Of the flat worm, there is 

1. The Bothriocephalus Latus — the Broad Tape worm. 

It consists of a head, a chain of articulations more or less long, and 
a small round tail. 



clxxvi. 

The head varies in size and shape from the Taenia Solium. It 
is oblong, and furnished with two, and sometimes four, oval fossets, 
or depressions, in the middle which is the mouth, or opening into the 
alimentary canal. 

The articulations in this species are broader than they are long. 
It is found in the small intestines of the inhabitants of Poland, 
Russia, Switzerland, and some parts of France, but it is not so gen- 
erally met with as the Teenia Solium. It rarely exceeds in length 
fifteen to twenty feet, although they have been found longer. 
The colour is generally a dusky white. 

Another distinction' qf this worm is, that it seldom parts with its 
joints spontaneously. 

Three, four, and even more of these worms have been found in the 
same person, but they seem to be peculiar to the inhabitants of the 
countries just mentioned, and where they prevail the Teenia Solium 
is not to be found, at least in the same subbject. 
2. Teenia Solium — Common Tape worm. 

It has been called the solitary worm. F*om this circumstance, a 
conclusion has been drawn, which seems well established, that the 
smaller the wOrm, the more numerous are they found to be, and the 
larger the less numerous : hence the above term, bestowed upon this 
species. 

This animal consists of a head placed at the smallest extremity, 
and a chain of articulations more or less broad or long, which gradu- 
ally enlarge as they advance, and at length terminate in a tail formed 
by a rounded joint. Each of these joints contain their proper viscera, 
and they are very easily separated from each other while the animal 
is alive. Each joint, when detached, has the power of retaining for 
a considerable time, its living principle, and is called, from its resem- 
blance to the seed of the gourd, Vermis Cucurbitinus. The separa- 
ted joints do not appear capable of retaining their situation for any 
length of time, but are soon forced clown the intestinal tube, and at 
length creep out, or are expelled per anum. 

It has been conceived that these Vermes Cucurbitinse have the 
power of forming fresh joints, but this I do not consider probable — 
the head alone having this property. Their re-production too would 
appear to be very rapid, were we to judge from the number expelled 
from persons subject to the tape worm. Certain it is, that when the 
whole is voided, except the head, in a short time after fresh joints 
are generated, and the patient is as much troubled with the worm as 
before. 

The Teenia is always found in the jejunum and ileum, occupying 
their whole length. 

The small intestines would seem to be the natural residence of 
this worm and the Lumbricus. Should their residence be made un- 
comfortable, they are readily removed from the system, either by 
vomiting, when they creep into the Stomach, or with the discharges 
of the bowels, when they pass the valve of the ccecum. 



4 



clxxvii. 

They are mostly of a pale white colour, and are of a very great 
length, varying from ten to thirty, and it is said one hundred feet. 

The origin of worms is still buried in much obscurity, and it is 
probable that the speculations which may be formed upon this subject, 
will never remove all the difficulties towards a satisfactorysxplana- 
tion. All that we know certainly, is, that whenever a nidus is form- 
ed, favorable to their production and growth, there we see them gen- 
erated and supported. 

Climate seems to have a considerable influence in the developement 
of worms. They are more frequent, 'all other things being equal, in 
moist and cold, or moist and hot countries, than under other circum- 
stances. 

Ascarides are very common in Holland. In certain parts of Swit- 
zerland, the Tape worm is of very frequent occurrence — women 
being more affected than men. To the moisture and heat which 
prevails about Grand Cairo, in Egypt, during the season of the inun- 
dation of the Nile, are we to attribute the frequency of this species 
of worm in that country. 

Season also influences their production. Thus they are observed 
by all physicians to be more common in summer and in the autumn, 
than at any other period, especially in those countries where fruit 
and pulse are eat, and when the influence of this vegetable diet is not 
corrected by the use of fermented drinks. 

That particular states of the alimentary canal give rise to them 
we are convinced of, from this fact, that the several species mentioned 
belong exclusively to the human system, and that when carried 
out of it they speedily die. They are found in robust, and in 
feeble habits; in children as well as adults, and in all climates; so 
that we are at a loss to determine the particular condition of the in- 
testines, which favours their production. 

They are most commonly found in children with weak digestive 
organs, and feeble constitutions, a state of body favorable to the pro- 
duction of mucous, which has been thought to serve as ' a nidus for 
their further developement and support. Hence it is that poverty in 
diet, and one consisting of crude vegetables, and unripe fruit, has been 
observed favourable to the production of worms, and hence they 
always abound in the low and poorer classes of society. 

It has been long a disputed question, whether worms were harm- 
less to the system, or whether they were in themselves a primary, 
or accessory cause of disease. 

When we consider how universally worms are found in all young 
animals, and how frequently they exist in the human body, without 
their presence being suspected, we should be disposed to conclude, 
that they perform some essential and necessary offices in the animal 
economy. When we find them too existing in the robust, and healthy, 
without any interruption to the functions of life, we may venture on 
the assertion, that in a certain degree they are harmless. When too 
we consider the infinite order and mutual subservience" of every part 
23 



clxxviii. 

of the natural chain of animated creation, and their adaptation to 
some useful purpose, we should be disposed to say that nothing was 
created in vain. 

It is only, I believe, when their number is increased to such a degree 
as to disturb the regular operations of the system, i. e. producing such 
a degree of irritation that the natural sympathies are awakened, or 
probably from a misplaced situation of the worm itself, that disease 
is produced. Under these circumstances, the diseases will be found 
as numerous and diversified as the sympathies of the intestinal canal 
with the various parts of the body. 

The whole train of nervous and convulsive diseases are excited by 
this cause, as chorea, epilepsy, convulsions, hydrocephalus, paralysis, 
and a variety of other nervous and convulsive affections. Be- 
sides these they have been said to produce pleuritic and rheumatic 
pains, dysentery, remitting fever, chronic and spasmodic cough, cy- 
nanche trachealis, &c. 

Thus is exhibited a striking instance of the influence of one ex- 
citing cause, in bringing into action a variety of diseases, according 
to the predisposition of the patient. This, you observe, varies in 
different individuals, hence such a diversity in their diseases appears. 
In every individual, therefore, there are particular weak parts, which 
are less liable to resist disease than others, and hence upon any irri- 
tation being excited, the disease appears with most violence in such 
part. It rarely, therefore, happens in fever, that there is simple ex- 
citement alone, but most commonly pain in some particular organ is 
felt. This pain is only a proof that such organ is less able to resist 
the increased excitement than another. The same may be said in 
these cases. The irritation excited by the worm, brings into action 
the particular form of disease to which the system is predisposed. If 
they are capable of producing the various disturbances in the system, 
I have mentioned, they are capable of producing a fever, several cases 
of which I have seen in practice. I would caution the younger part 
of my hearers, that these cases are of less frequent occurrence than 
is commonly supposed, and that great mischief is sometimes done, 
by treating the disorders of children as worm cases which really are 
not so. Popular prejudice is too apt to attribute to the existence of 
worms the diseases of children. 

Dr. Hunter, we are told, dissected great numbers of children, who 
had been supposed to die of worm fevers, and whose complaints 
were of course treated as proceeding from worms, in whom, however, 
there appeared on dissection, to be not only no worms, but evident 
proofs of the disorders being of a different nature. 

This caution is of the more importance, when it is considered, that 
the symptoms commonly attributed to worms alone, may be produced 
by a foulness of the bowels. Hence I would introduce a practical 
remark which is of consequence, that in the treatment of such cases, 

atisfied in administering to their patients 
in Anth( 



clxxix. 

to join them with those which are particularly adapted for cleansing 
the primse vice, as it is uncertain whether a foulness of the bowels 
may not be the cause of all the complaints. 

By pursuing this plan we obviate the dangers which may arise, 
from accumulations of acrid matter being retained in the bowels, at 
the same time, by combining a medicine of an Anthelmintic quality, 
we effect the expulsion of the worms should they really exist. 

That worms, however, produce a worm fever I have already sta- 
ted, and as it is not of very frequent occurrence, its symptoms may be 
mentioned in this place. 

It has no regular symptoms by which it is distinguished. 

It generally assumes a remittent character, the excitement never 
running very high — the faculties of the patient are not often much 
disturbed, but there sometimes exist considerable heaviness or drow- 
siness, often the reverse, with great fretfulness, the child being satis- 
fied in no other situation than in the arms, and moving about. Oc- 
casionally there attends twitching of the muscles, or starting in the 
sleep, with a grinding of the teeth. Pain, we would suppose, exists 
particularly in the abdomen, from the cries of the child. One cir- 
cumstance, alone, often leads me to suspect the origin of the fever, 
which is, its not being much affected by the depleting remedies em- 
ployed in such cases ; and notwithstanding their operation is carried 
to a proper extent, the symptoms continuing with a steadiness and 
obstinacy which would lead one to suspect some more dangerous af- 
fection. If, at this period, Anthelmintic medicines are employed, 
and under these circumstances, the Spigelia Marilandica is one of 
the best, not only from its anthelmintic properties, but its febrifuge, 
every symptom which had been previously so obstinate, will subside 
in the course of twelve hours, with the discharge of worms. 

I have seen the same effect take place from four, twelve, twenty 
and sixty being expelled from the body. This effect I have so often 
witnessed that I have no hesitation in asserting it. From this state- 
ment, it is obvious that the symptoms are not produced by their 
numbers alone. They will be equally produced by a change of situ- 
ation in the worm, the irritation of which is often alone sufficient. 

The Lumbricoides, for it is to these I allude to particularly, being 
generated and inhabiting particular tracts of the intestinal canal, 
these parts, we may venture to suppose, are less affected by the irri- 
tation their presence produces than others. 

When, from any cause a change of situation occurs, and they re 
move from their accustomed abodes, disease is often excited, and this, 
I have observed, is as considerable from the presence of a few, as from 
many. 

The peculiar symptoms Dr. Chapman has described, as attending 
upon a worm fever, I have never seen in a single instance. 

I conclude my general description of worms, and will proceed to 
speak of the articles adapted to their expulsion. The arrangement 
I shall pursue, will be, to consider under one head the articles best 



clxxx. 

adapted to a particular species of worm, as this appears to be the 
clearest order, I can adopt, recollecting, only, that some of the arti- 
cles may be employed indiscriminately in all the different species. 

Before proceeding to their consideration, it may be proper to point 
out the symptoms by which the presence of the Lumbricus may be 
indicated. 

These may all in a greater or less degree be referred to intestinal 
irritation, and the symptoms which usually occur, are, pains in the 
abdomen, itching in the nose, nausea, vomiting, looseness of the 
bowels, slender intermitting pulse, epileptic convulsions. To these 
are added a pale and occasionally a flushed countenance — the eyes 
are dull and heavy, the pupils dilated or much contracted, there is 
tumefaction of the upper lip, and eyelids, the breath is foetid, the 
sleep is disturbed, during which the patient grinds his teeth, or starts 
suddenly as if frightened. The appetite is variable, being sometimes 
suppressed, and at others exceedingly voracious, the abdomen is much 
tumified and hard. 

The above are the most common symptoms usually met with. It 
is not to be understood that they all occur in the same case, but some 
of them will generally be present.* They may, however, all be 
absent, and nothing will lead to a knowledge of the existence of 
worms but their actual discharge. 

References — Brera on Worms. Memoirs London Medical Society. 
Bremser Traite des vers Intestinaux. 

PARTICULAR ANTHELMINTICS, 

And the articles adapted to the expulsion of the Ascaris Lum- 

bricoides. 

Family Gentianea — Spigelia Marilandica or Pink Root, is a native 
plant, and is to be found in all the southern parts of the United States. 
The roots are perennial, with many fibrous branches, of a yellowish 
colour when first dug out of the earth, but becoming black when 
dried. 

Description of the Plant. 

Stem, herbaceous, six to twenty inches high. 

Leaves, sessile, ovate, lanceolate, acute. 

Flowers is a simple secund raceme, yellow within, crimson 
without. 

Every part of the plant may be employed as a vermifuge, but the 
root is unquestionably the most active. For its efficacy as an An- 
thelmintic it has long been celebrated, and was first recommended in 
the Edinburgh Physical and Literary Essays, by the late Dr. Garden, 
of this city. 

The reputation which it had acquired it well sustains, and most 

* In one case, which fell under my observation, no other symptom was present 
but a constant pain in the abdomen, and upon employing Anthelmintic medicines, 
twenty-five worms were discharged. 



clxxxi. 

practitioners will agree in the decidedly beneficial effects, resulting 
from its employment in this species of worm. It is, without doubt, a 
poisonous and narcotic vegetable, and it is probably by virtue of this 
poisonous quality that it proves so beneficial in worm cases. It has 
been said to operate most favorably when it purges, and its good ef- 
fects have been ascribed to this quality, but from long experience 
with the Spigelia, I am safe in saying that it seldom or ever purges, 
and that it is necessary to follow its employment with cathartic 
medicine. Its effects would appear to be of an intoxicating and de- 
bilitating character upon the worm, in consequence of which, by the 
peristaltic motion of the bowels being quickened, they are readily 
carried through the tract of the intestines, and finally expelled. 

The Spigelia has been objected to, from its supposed tendency to 
produce drowsiness, violent pain in the forehead, and temporary loss 
of sight, with tremors, convulsions, and death. These objections 
appear to have been transmitted from one writer and practitioner to 
another, without a proper consideration of the subject. 

Thus, Dr. Chalmer's in his History of the Climate and Diseases of 
South-Carolina, Page 67, says, that of all the vermifuges he is ac- 
quainted with, Indian Pink is decidedly the best, but it must be pro- 
perly guarded to prevent drowsiness, violent pain of the forehead and 
eyes, and a temporary loss of sight, which often ensue from the use of 
it ; nay, it affects the nervous system to such a degree, that convulsions 
supervene, as happened to two lusty children in one family, of seven 
and five years of age, owing to the too free use of this plant, before 
its properties were well known to us. 

To this catalogue of the dangerous and deleterious effects of this 
medicine, I can only add, that after an extensive use of it, in every 
variety of constitution, and at every period of life, I have never known 
these effects to occur in the degree described.* 

In confirmation, I may add, that Mr. Home, who performed a 
number of experiments with it, says, that in none, not even in those 
cases where the bowels were confined, did it produce vertigo, dimness 
of sight, or convulsions, as we have been told, nor did it excite any of 
the effects of the narcotic poisons. I would not wish to be under- 
stood as asserting that these effects never take place, the fact lias 
been stated by several very respectable writers, and we are to con- 
sider the occurrence as taking place, though, I believe, it is more 
rare than is commonly supposed. 

We have the authority of the late Dr. McBride, that its narcotic 
effects are seldom or never attended with danger, and that some 
physicians consider them an evidence of the favorable operation of 
the medicine. 

The symptoms commonly subside in the course of about twenty- 
four hours, leaving the patient as well as before taking the Pink 
Root. 

* Except in one case where an exceedingly strong infusion had been given. 



clxxxii. 

It has been said, that the deleterious effects observed in the em- 
ployment of the Spigelia, do not depend upon the root itself, but 
upon a small vine which entwines itself about the plant, and to 
which all its bad effects are to be attributed. The opinion, however, 
is wholly without foundation. 

The Spigelia Marilandica is used as an anthelmintic in powder or 
infusion. Of the powder, from five to ten grains may be given to a 
child two years old ; and to an adult ^ss. to 3H. combined with calo- 
mel, or any other purgative, and, thus combined, its narcotic effects 
are never observed. 

I prefer, however, the infusion.* 

In this form it is much more efficacious, and it is proper to pursue 
the administration of the infusion for thirty-six hours or two days, 
when a cathartic should be given, either mercurial or castor oil. 
Given in this form it rarely fails to bring away worms, if there are 
any present, and the success which has followed its use, has long 
satisfied me that it is one of the most valuable anthelmintics we 
possess. 

The Spigelia Marilandica enters into the composition of several 
quack medicines, the most celebrated is Leman's, which is a com- 
pound of Spigelia and Senna, with a little of the leaves of Savin, 
perhaps only to disguise it. 

This compound is very efficacious, and is said to produce none of 
the nervous effects that have been mentioned of the Spigelia Mari- 
landica. 

Besides its anthelmintic property, the Spigelia is well adapted to 
some of the febrile diseases of children, unaccompanied by worms, 
especially in the insidious remittent, which so frequently lays the 
foundation of dropsy in the brain. Here it seems to exercise an ex- 
cellent febrifuge property, and its employment will afford very satis- 
factory results. 

Dr. Chapman is satisfied that every practitioner who has largely 
used the medicine must have seen it do good in the febrile affections 
of children, though no worms are brought away. 

The Spigelia loses its activity by being long kept, and should not 
be employed after it has been gathered longer than a twelve-month, t 

References. — Thompson's Inaugural Dissertation, 1802. Essays 
and observations, Physical and Literary, Vol. I. page 386. 

* The infusion is prepared by pouring a pint and a gill of boiling water upon 
two drachms of the roots, and simmering down to a pint. This is sweetened 
with molasses, and may be given in doses of a wine-glassful in the twenty-four 
hours. Thus prepared, it is more readily taken by children, than the powder, 
which being light is very bulky, and therefore with difficulty swallowed. 

t If you prefer giving the powder, I would advise you to prepare it yourselves. 
That which is met with in the shops is often very old, and prepared from the plant 
after the roots, which are fine and delicate, have been broken off, and the article 
from not being saleable, is pulverised. 



clxxxiii. 

Family Meliacem Melia Azedarach — Pride of India — Poison 

berry tret. — This tree which has become naturalised in the States of 
Carolina and Georgia, was originally introduced from the Island of 
Japan in the East Indies. By whom it was brought into this country 
I have been unable to learn, but that it is well adapted to our climate, 
its luxuriant growth and the universality of it, abundantly testify. It 
has for some time been in repute, for its medicinal virtues. Among 
these are the strong anthelmintic powers which it possesses, in the ex- 
pulsion and destruction of the Ascaris Lumbricoides. Of its efficacy 
in this respect, the late Dr. Barton spoke in very high terms, and con- 
sidered it so valuable an anthelmintic that it deserved to be intro- 
duced into general practice. Dr. L. Kollock of Georgia, also speaks 
of it in similar terms, and considers it a vermifuge of great efficacy. 
Of this article I can say but little from my own experience, being so 
well convinced of the virtues of the Spigelia, that I have seldom re- 
sorted to any other. It is, however, very much employed by the 
planters of our state, and their opinions of its utility fully corroborate 
the above statements— they even declare that it has exhibited good 
effects, after the Spigelia has failed. The root, or what is better, the 
bark of the root is employed, and is best exhibited in the form of de- 
coction. 

The following are the directions for preparing it. 

The outer covering of the root is to be scraped off, and about four 
ounces of the bark of the fresh root, is boiled in a quart of water, 
until it acquires the colour of strong coffee, or until it is reduced to a 
pint. Of this half an ounce or an ounce may be given every two or 
three hours, until it operates, which it does both by vomiting and 
purging. Where this effect is not intended, it is commonly given in 
the quantity of a tea-cupful for several evenings, and a cathartic is 
then exhibited. The cases to which it is best adapted are those of 
the common round worm, or Lumbricus intestinalis. Whether it is 
equally efficacious against the Taenia or tape worm, I am not suffici- 
ently informed. It has been said to be also useful in this species. 

This article, like the Spigelia, is a good febrifuge medicine, in those 
affections usually denominated verminous fevers, but where no worms 
are voided. 

Michaux, the celebrated French botanist, states, that the pulp which 
invests the stone of the fruit, when pounded with tallow, proves a 
good application in cases of Tinea capitis in children. 

The following interesting facts respecting the use of the Berries 
of the Pride of India, proving their utility as an Anthelmintic, 
were communicated to me by a friend. Two negro girls were 
placed under his care, in a very feeble state of health, so much 
so that they were not thought likely to live. To general emaciation 
was added tumid and enlarged abdomen of a considerable size — skin 
hard, unperspiring, and the whole appearance unhealthy. Worms were 
suspected, and from the strong anthelmintic properties of all parts of 
thetn .' ■ upf sed that the! Ties would he «rHu?<?. with sirm- 



clxxxiv. 

lar powers, while their use would be more agreeable and convenient. 
Accordingly they were collected when ripe and juicy, and the girls 
were directed to eat a gill of the berries before breakfast, rejecting 
the stones. They were directed to increase the quantity to a pint or 
more during the day. The taste of the fruit is a bitter sweet, not dis- 
agreeable, but which improves so much upon the palate that after a 
while they become agreeable. 

This course was continued a fortnight or three weeks, when my 
friend was informed by one of the girls that a substance was dis- 
ci: wrged from her to which she called his attention. Upon inspec- 
tion it proved to be the Taenia or tape worm. The plan was contin- 
ued, and soon eighteen feet more were discharged, and sjpon another 
portion, about seven feet in length. Other portions of a few feet, and 
a foot until it was presumed the whole had been removed. The 
health improved, the tumid abdomen subsided, and the patient restored 
to health. 

The other girl discharged a large number of Lumbrici, and re- 
covered. 



Family Chenopodecc — Chenopodium Anthelminticum — Jerusalem 
Oak. — Characters — Leaves, oblong, lanceolate, sinuate, dentate, race- 
mes naked. 

Root, perennial. 

Stem, herbaceous, erect, furrowed, branching, four to six feet high. 

Leaves alternate, nearly sessile, glabrous, strongly veined. 

Flowers in axillary, leafless spikes, which towards the summit of 
the branches become densely crowded. 

This plant is a native of Buenos Ayres, but grows in various parts 
of the United States, and in the neighbourhood of this city. It is 
said to be an excellent anthelmintic, and this property resides in every 
part of the plant, but the seeds are the most powerful. It is employ- 
ed in several ways. Either the juice is expressed from the leaves 
and. given in the dose of a table-spoonful morning and evening, upon 
an empty stomach, or more commonly the seeds are powdered, and a 
table-spoonful is given, enveloped in honey or mucilage. The dose 
to be repeated for several successive days. 

From the seeds, however, there has lately been extracted an oil, 
which has been much recommended in cases of worms. It is said 
by Eberle to be an exceedingly active vermifuge, and that he has suc- 
ceeded in many cases in expelling numbers of Lumbrici with it, after 
various other anthelmintics had been tried in vain. The oil is the 
preferable form for its exhibition, and after being employed for several 
days it is to be suspended, and a cathartic administered. If worms 
are not discharged, recourse must be had to the oil again. 

The dose for a child under two years, is five drops, mixed with a 
good deal of sugar or mucilage, and from two to five years, from five 
to ten or fifteen drops ; for an adult, from twenty to thirty drops. 



clxxxv. 

The principal objection to this article is its extremely unpleasant 
odour and taste, which are so tenacious as to remain for several hours. 
Could it be dispossessed of these qualities, it might be introduced into 
more general practice. 

Family Leguminosce — Geoffrcea Inermis — Cabbage tree bark. — 
This tree, of which the bark is used as a vermifuge, is a native of 
Jamaica and the other West India Islands. It has lately been intro- 
duced in the Materia Medica, and is spoken of by the physicians of 
the West Indies as an anthelmintic of great power and efficacy, but 
is little employed by the physicians of this country. 

Dolichos Pruriens — Cowhage. — The dolichos is a climbing plant, 
growing in great abundance in warm countries, particularly in the 
West Indies. It has pods, thickly beset on the outside with stiff 
hairs, which, when applied to the skin, occasion a most intolerable 
itching. 

This medicine has been much used in the treatment of worms, the 
part employed being the hairy spiculse, scraped from the pods and 
mixed with syrup. They are supposed to act mechanically upon the 
worms, but occasion little irritation to the surface of the primee vise, 
as it is protected by a mucous covering. 

Mr. Bancroft in his natural history of Guiana, in South America, 
gives an interesting account of this article. After speaking of the 
frequency of disease from worms in that country, and the insuffici- 
ency of the usual remedies for their destruction, he states, that the 
planters have recourse to the Cowhage for that purpose. From 
whence its use was suggested is uncertain, but its efficacy is indispu- 
table. The part used is the hairy substance growing on the outside 
of the pod, which is scraped off, and mixed with common syrup to 
the consistence of a thin electuary, of which a tea-spoonful to a child 
of two or three years old, and double the quantity to an adult, is 
given in the morning fasting, and repeated the two succeeding morn- 
ings, after which a dose of Rhubarb is subjoined. 

The patient, it is added, after the second dose usually discharged 
an incredible number of worms, so that the stools consisted of little 
else than these animals. But though there are sufficient proofs of its 
efficacy, some doubts have been entertained of its safety. For con- 
sisting of a number of spiculse, exquisitely fine, and so acutely pointed 
that when applied to the skin they excite an intolerable itching, and 
even inflammation. Hence it might be apprehended that dangerous 
consequences would arise from their contact with the coats of the 
stomach and bowels. 

From the experience of those who have employed it extensively in 
practice, it would appear, that these objections are entirely theoretical, 
and that it may be given with perfect safety. That its good ef- 
fects are derived from its mechanical operation, is proved by this cir- 

24 



clxxxvi. 

cumstance, that Cowhage has been given in tincture and decoction, to 
worm patients, without any sensible advantage. 

The dose of the cowhage mixed with syrup, to the consistence of 
an electuary, is a tea-spoonful to a child, and a table-spoonful to an 
adult, repeated in the morning for several successive days. 

The worms are said to appear with the second or third dose, but 
the operation of the medicine is to be promoted with a purgative 
dose. 

This remedy is particularly designed to destroy the long round 
worm, the species of which I am treating 

The dolichos is a vermifuge interesting from its character, but which 
is seldom or never resorted to in this country. 



Camphora. — Of all the remedies for Lumbricoides, Professor Brera 
thinks there is none equal to camphor. The anthelmintic powers of 
camphor were known some time since, and its efficacy has been again 
recently noticed. By the Italian physicians, it is generally preferred 
to other vermifuges. 

Half a drachm is given in the form of mixture rubbed up with 
mucilage of gum arabic, and this is administered in doses of a table- 
spoonful frequently repeated. 

The employment of camphor is also attended with this advantage, 
that it counteracts the predisposition to the further developement of 
verminous ova. 

I have always used it, says Professor B. with the greatest success, 
and cannot too strongly recommend its use to physicians in worm 
complaints, whether given in the mode already mentioned, or some 
other, combined with other remedies. 



Besides these articles, there are various medicines which having a 
purgative operation, have been employed for the expulsion of worms. 
The Ascaris Lumbricoides not being very tenacious of life, is easily 
destroyed and evacuated by their use. The purgatives which have 
been most commonly employed, are, calomel alone, or combined with 
jalap, helleborus fcetidus, scammony, aloes, muriate of soda, &c. 

Calomel, as a vermifuge, has long been held in repute, and its 
powers, in this respect, have been the subject of eulogy by most phy- 
sicians. It has even been said that the crude metal boiled in water, 
and the water drunk, has been effectual in these cases. But the 
water, it is evident, can receive little impregnation from the mercury, 
and if it has any effect, it must be from foreign or accidental impreg- 
nation. 

Calomel, however, is a very useful anthelmintic, but to be effica- 
cious it must be given in a large dose at night, and worked off the 
next morning with castor oil, or some other cathartic. Or it should be 
repeated at short intervals, in order to remove such worms and ova, as 
have been screened from the preceding dose, by the folds of the in- 
testines, or in mucous. 



> 



clxxxvii. 

A cathartic should be exhibited to remove it from the system, so 
as to prevent salivation. Combined with jalap it often brings away 
worms when given for other purposes, and it is a very common in- 
gredient in all the nostrums advertised for the cure of worms. It 
is also a very useful auxiliary to the more decided vermifuge medi- 
cines. 

Fifteen grs. of Jalap, the same quantity of Rhubarb, and five grs. of 
Calomel, will generally expel Lumbrici, when given for three or four 
mornings in succession. 

Helleborus Fatidus — Is a native of this country as well as Europe. 
It grows in swamps and meadows, has a very offensive smell and an 
acrid taste. It operates powerfully as an emetic and cathartic. In 
doses of five or ten grains, to an adult, of the powdered leaves every 
night for several in succession, it operates as an active anthelmintic, 
and for this purpose has been recommended by several European 
practitioners. It should not, however, be employed till safer anthel- 
mintics have been tried in vain, for the imprudent administration of it 
has been attended with fatal consequences. 

This very active article is still retained in the Materia Medica as 
an anthelmintic, but no one at the present day thinks of using it. 

The next article I shall speak of under this head, is the Chloride 
of Sodium, or common salt. The practice of using this article is 
very ancient and common in some countries. In Ireland it is the 
custom to feed children, who are afflicted with worms, for a week or 
two upon a salt sea weed, and when the bowels are well charged with 
it, to give a purgative dose, in order to carry off the worms after they 
have been debilitated by the salt diet. 

In his own practice, Dr. Rush says that he has administered many 
pounds of common salt, coloured with cochineal, ^ ith great success 
in destroying worms. 

Dr. R's. formula, was the following. 
fy. Chloride of Sodium, fii. 

Cochineal, 3ii. m. ft. Pulvis. 

Of this 3ss. to 3L was given in the morning on an empty stomach. 

The value of Salt as an anthelmintic may be inferred from the 

practice in some countries, of compelling criminals condemned to 

death, to live upon a diet without salt. Multitudes of worms being 

thus produced, from which death was ultimately the consequence. 

The ancient laws of Holland ordained as a punishment to crimi- 
nals, that they be kept on bread, unmixed with salt, as the severest 
punishment which' could be inflicted. The effect was horrible, the 
criminals being devoured by worms engendered in their stomachs. 
Mr. Marhsall has related the case of a lady who had a natural an- 
tipathy to salt, and was, in consequence, infested with worms during 
the whole of her life. 



clxxxviii. 

Its importance to animals generally, is evinced by the long journeys 
they have been known to take to reach what has been called the salt 
licks. 



Before completing our description of the remedies adapted to the 
Ascaris Lumbricoides, it may be proper to say a few words upon an 
article of which much has been said within a few years. I mean 
the Cedar Apple. 

A paragraph appeared in our newspapers some time ago, setting 
forth in extravagant terms the efficacy of this substance. The para- 
graph stated, that some children, on a visit to a friend in one of the 
Northern states, took from the limbs or twigs of the cedar tree, what 
is generally called the cedar apple or knot. One of them, who had 
always been afflicted with worms from the age of two years, and for 
whose relief every thing had been tried, in the power of a skilful 
physician, but to no effect, and was then in a delicate state of health, 
eat several of the apples. The consequence was, that several worms 
were expelled from her. The remedy was again administered, and 
in the course of twelve hours, three hundred and upwards came from 
her. The father of the girl, to be satisfied of its efficacy, gave the 
apples to five of his children, who were all in health. It had the 
same effect of expelling worms from them. He also eat several him- 
self, and the effect was the same. Thus, it is added, through the 
medium of mere chance, perhaps one of the best remedies, and the 
most simple, has been discovered. 

The apples were recommended to be eaten nine mornings in succes- 
sion, fasting. Or if dry, to be pounded fine, and taken in molasses, 
or eat just as they come from the tree. 

The apples are not to be confounded with the seeds. They are an 
excrescence from the Juniperus Virginiana or Red Cedar, and are 
produced by the puncture of an insect, of the bark or young branches. 
The sap exudes and forms the substance in question. It is formed in 
short in the same manner as the gall nut. Its sensible properties are 
considerable astringency and bitterness. 

An article, the virtues of which were set forth in such extravagant 
terms, would not be allowed to remain unemployed for any length of 
time. Considerable eagerness was therefore manifested to experiment 
with it, and many cases, in which worms were suspected, were sub- 
mitted to its operation. I am not sufficiently informed of the result 
in these cases, to speak positively of its powers. In two cases in 
which I employed it, considerable irritation of the stomach was pro- 
duced, and the remedy was discontinued. In another, in which it 
was tried by a physician of this city, it did not produce the desired 
effect. 

Dr. Brocchus, a writer in the Philadelphia Journal, instituted ex- 
periments with reference particularly to its vermifuge powers. It was 
employed by him in six different cases, and the result was sufficient 
to satisfy him that the article possessed considerable activity as a ie- 



clxxxix. 

medial agent, but that, upon the whole, it was not superior to many 
others, which are employed with the same intention. 

The modus operandi seems to be by virtue of the bitter principle 
which it contains, proving a poison to the worms, and also by its 
tonic powers overcoming that condition of the alimentary canal, 
upon which their generation is supposed to depend. 

The dose in which it is given is from ten to twenty grains, two or 
three times a day, and this pursued for a week. 

During the administration of the powder, a decoction of the apples 
made pretty strong, may be given, in doses of a tea-cupful several times 
a day. 

The quantity directed by the person who introduced the apple to 
our notice, was one for every year of the person's age, as they are 
taken from the tree, and this generally continued for nine mornings 
in succession, fasting. Thus taken, however, the quantity would be 
very variable, depending upon the size of the apples, varying as they 
do from the size of a pea to that of a small nut. The medium dose 
would be such as I have stated. 

A more agreeable mode of exhibition, and one that I have been 
informed has proved effectual, is in the form of tincture, of which |ss 
may be administered several times a day, and thus employed, or in 
the form of decoction, its irritation upon the stomach would be less 
felt. 

It may be an article worthy of further investigation, and would 
afford a good subject for an inaugural dissertation. 



Having completed the consideration of the remedies which are em- 
ployed in the treatment of the long round worm, I shall proceed to 
those of another species of this class, the Ascaris Vermicularis or 
Ascarides 

Previous to entering upon them, I shall consider the symptoms, 
seat, and other circumstances connected with their presence. 

The Ascarides are about half an inch in length, and their usual 
seat is the rectum. The symptoms they produce are an uneasiness 
in the part, and an almost intolerable itching in the anus, which sen- 
sations usually come on in the evening, and prevent sleep for several 
hours. 

They are attended with heat, sometimes so considerable, as to oc- 
casion a swelling in the rectum, both internally and externally, and 
if these symptoms are not relieved a tenesmus is brought on, with a 
a mucous dejection. Sometimes there is a griping pain in the lower 
part of the abdomen a little above the os pubis. In addition to these 
symptoms, they are often found in the bed-clothes, or discharged with 
the alvine evacuations. 

The general health of the patient is not much impaired, from the 
long continuance of the disease, and this kind of worm, though as 
difficult to be cured as any, yet is the least dangerous of all. They 
have been known to accompany a person through a long life, without 



cxc. 

any reason to suspect they had hastened its conclusion. They are 
difficult of cure, in consequence of their tenacity of life, and by bury- 
ing themselves in the mucous of the first passages, they resist, in a 
great degree, the action of medicines. Hence some peculiarity in 
their treatment. 

One of the difficulties which I have mentioned in the treatment of 
these worms, depends upon their becoming imbeded in the mucous of 
the bowels, by which they resist the action of medicinal agents. 
It is this which preserves them unhurt, though surrounded with 
many other liquors, the immediate touch of which would be fatal. 
Purgative medicines by lessening this slime, never fail to relieve the 
patient ; and it is not unlikely that the worms which are not forced 
away by this quickened motion of the intestines, may, for want of a 
proper quantity of it, languish and at length die. 

Of the kind of purgatives best adapted to this purpose, great dif- 
ference of opinion exists, some recommending the brisker, and others 
the more mild cathartics. It seems, however, that those purgatives 
are the best, which while they operate with sufficient activity, do 
not enfeeble the patient to such a degree but that a repetition can be 
easily borne. 

Those mineral springs which contain much saline matter are of 
this sort. 

Jalap mixed with sugar, in small doses, is efficacious in children, 
as it can be repeated daily. 

Cinnabar and Rhubarb, in the quantity of half a drachm each is 
very useful, as it never fails to bring away a mucous as transparent 
as the white of an egg, and in this many Ascarides will be found. 

Calomel too has been spoken of with much confidence of success, 
but I believe with little more benefit, than any other purgative which 
operates briskly would have done. 

Aloes, and its preparations, have been much prescribed, from their 
known tendency to act upon the lower portion of the intestinal canal, 
in which these animals reside. In the ordinary dose it is sometimes 
very effectual, but the Hiera Picra, which consists of Aloes and Ca- 
nella Alba, is a more powerful remedy. It is a very popular remedy, 
and has often succeeded when other means have failed. In the ordi- 
nary manner of prescribing it, an ounce of the powder is dissolved in 
a pint of ardent spirits, of which sufficiently digested, a table-spoonful 
diluted may be given to a child four years old, and repeated until it 
operates. Or the Elixir Proprietatis, or Compound Tincture of Aloes, 
in doses of 31!. to f ss. repeated two or three times a day, or night and 
morning. 

With purgatives, however, other means are required. These are 
Enemata or Glysters. 

They become necessary from the tenacity of life which these 
worms exhibit, and from their being seated far from the stomach med- 
icines administered by the mouth, have little other effect upon them, 
than as they evacuate the contents of the rectum in common with 



CXC1. 

the other viscera; but administered in this way, the relief afforded is 
very considerable, though not in all cases certain. 

The injections most approved, are those of 

Aloes, 3L to 3ii. dissolved in a pint of new milk, and injected 
twice a day. 

A weak infusion of Tobacco — a solution of Assafoetida — Lime 
water — Olive oil — Camphor. 

The injection of Camphor, which I believe to be the best, is pre. 
pared in the following manner. 

fy. Camphor, 31., olive oil fii. m. for an enema. 

It is to be administered at bed-time, every third night, at three dif- 
ferent periods, or it may be repeated on alternate nights. 

This has been found a more efficacious remedy against the violent 
itching, and other painful symptoms of the anus occasioned by these 
worms, than most of the rest. It generally gives some immediate 
ease, and stays all night without inconvenience. In the morning it 
comes away with a natural stool, or without, and with it many dead 
worms are removed. 

Solutions of salt, either tepid milk well salted, or a table-spoonful 
of salt, dissolved in half a pint of water, are very efficacious, and 
the late Dr. Kuhn of Philadelphia observed, that he hardly ever 
knew it fail. 

The Spirits of Turpentine enveloped in mucilage, or the yolk of an 
egg is also valuable. 

With these injections the rectum should be filled, but the quantity 
thrown up should never be so great as to produce great distension 
of its cavity, lest the coats of the bowels being stimulated should 
hastily contract and expel the glyster, which acts with more cer- 
tainty if it remains a short time. The operation, repeated for a few 
successive days, will seldom fail to remove for a time the Ascarides, 
and the symptoms they produce. It will be proper too after the use 
of the injections, to administer a cathartic, by which the enfeebled 
worms will be brought away, and in the majority of cases this plan 
of treatment will succeed. 

The following case, detailing the symptoms connected with the 
Ascarides, and the treatment pursued, will be read with some interest. 

I cheerfully comply with your request that I would communicate 
what I know of a very troublesome affection, to which I have been 
subject during the greater part of my life, (I am forty-two years of 
age,) and of which I have only recently been relieved. 

I have been troubled with the small intestinal worm called Ascari- 
des, from my earliest childhood. As far as I can now recollect, from 
two to three dozen passed from me, on an average, per day, during 
my boyhood — the number, however, varied considerably. 

I recollect that when I was in any way costive, the number of 
worms that passed from me was not as great as under other circum- 
stances. At all times the eating of fruit, particularly apples, increas- 
ed the number discharged, and by bringing them into the rectum, 



CXC11. 

always rendered the symptoms more distressing. A couple of hours 
after partaking of this fruit, I was sure to be incommoded with 
Ascarides for a day or two. 

In my early life, the eating of cheese produced the same effect. 
This has not been so much the case with me for the last twenty 
years, although I have freely partaken of cheese. Any considerable 
degree of exercise increased them, and this was also the case when I 
partook of any liquid, containing much sugar or molasses. 

From my 18th to my 25th year, I was afflicted with a haemorrhage 
of the lungs, and was compelled to travel, to go to sea, &c, and 
during that time I was not so much troubled with Ascarides; on an 
average, not more than two or three passed from me in a day. 

I exchanged a northern for a southern climate, and my health 
gradually improved, and my consumptive symptoms have all left me. 

But the change of climate did not relieve me from Ascarides, on 
the contrary, they grew every day more troublesome, insomuch that 
I was kept awake night after night, for years together, and finding no 
relief but by taking two or three injections of water, during the 
night. I am sure that I speak within bounds, when I say, that for 
fifteen years, there passed from me, on an average from two to three 
hundred Ascarides per day. 

I cannot say that my bodily health was much injured by these 
worms, but the irritation they incessantly kept up, was very distres- 
sing, so much so, that for many years life has almost been a burden, 
and I found it was affecting my nerves, and with it my temper. 

I applied to physicians, and made use of various remedies, all of 
which afforded me but temporary relief. I took castor oil and mag- 
nesia for a whole summer — I was weakened, but not much benefitted. 
I made use of injections of vinegar and water, one of these would 
relieve me for a whole day, and destroy every worm within the lower 
part of the rectum, but I began to think that this was injurious to the 
intestines, and increased that particular kind of mucous in which 
these worms are found. I spent two summers at the springs of Sara- 
toga, and had at one time great hopes that these waters, which caused 
the worms to be evacuated, and operated as a tonic to the intestines, 
would have cured me. The relief was only temporary. On my return 
to Carolina the Ascarides became as troublesome as ever. I then im- 
ported the Saratoga water, and in the course of three years used one 
hundred dozen bottles : the use of this water saved me from much 
misery, but I found I had to increase the dose, till three bottles in a 
morning scarcely operated as a cathartic. I then had recourse to 
salts ; this so sickened and disgusted me, that I cannot bear to think 
of it to this day. 

I remember once having tried the experiment of eating an excres- 
cence growing on the cedar tree, called the cedar apple ; for a whole 
day the worms seemed quieted, and on the following morning I passed 
a pint of mucous, containing the remains of thousands of Ascarides : 
they had evidently been destroyed by the cedar apple. I thought I 



CXC11I. 

had found a specific. I procured a quantity of the cedar apples and 
had them made into pills, but it appeared to me that, in their dried 
state, they had lost all their virtues, and I have since used them with 
some advantage, but not so decided as I once thought. 

The medicines which you prescribed for me, I persevered in using 
for two months; you are acquainted with your prescriptions, and 
mode of treatment, allow me to say, that I think I have found most 
benefit from the preparation of aloes. I hope, that I can now say, 
that I am cured — for 6 weeks not a single Ascarides passed from me. 

This patient was placed upon the use of the Compound Tincture 
of Aloes, ^ii. or 3iii. night and morning, and advised Enemata pre- 
pared with Aloes as directed. Finding that they were so readily 
discharged by the Tincture, he omitted the injections, though, at 
times, when irritation was experienced, he would apply cold water 
or tepid milk. The coldness of the fluid always gave relief, and 
with the evacuation of it, some worms were discharged. In a little 
time, by this course being pursued, his uneasiness was greatly abated. 
He proposed discontinuing the medicine. I advised him still to em- 
ploy it, only at longer intervals, every other night or twice a week. 
This plan was pursued for two months, at the expiration of which 
time, the patient states, that he hopes he can now say he is cured. 
For six weeks not a single one passed from him. On one occasion 
he felt some irritation, and upon using an Enema of cold water, three 
or four were voided, since which time, having felt no further return, 
he has not resorted to the medicine, though several years have now 
elapsed. 



Trichuris Vulgaris — The third species of round worm, or the long 
thread worm. This is of rare occurrence, and as there is no pecu- 
liarity of symptoms attending its presence, the same treatment may 
be adopted as for the Lumbricus Intestinalis. 



Tania or Tape Worm. — One of the most difficult to be removed 
from the body. The reason of its being so difficult to expel is, that 
though portions of it are apt to break off and be discharged, it is en- 
dowed with a power of re-production, so that the patient is little or 
nothing better. 

Of the anatomy of the Taenia little is known. I may be allowed 
simply to state that the body consists of a callous parenchyma, that 
they have no abdominal cavity, nor intestines, properly so called, nor 
anus. They are generally regarded as possessing some sensibility, 
and as oviparous. But what relates to the history of their genera- 
tion, or of their nervous system is very obscure. We are also igno- 
rant of the duration of their lives, and it is also impossible in the 
present state of our knowledge, to determine upon the extent of their 
increase. 

The symptoms of this worm do not differ very materially from the 
foregoing. The most characteristic, are, pain in the abdomen, with 
25 



CXC1V. 

a turning motion or weight in the side, occasional prickings or bitings 
in the region of the stomach, with the evacuation per anum of small 
substances resembling the seeds of the gourd, which are the Vermes 
Cucurbitini. 

Of the remedies for the Teenia, 

Polypodium Filix Mas, or Male Fern. — This is a perennial plant, 
and grows in great abundance in almost every part of Great Britain. 
The only part used is the root, which when chewed is somewhat 
mucilaginous and sweet, afterwards astringent and bitter. 

The root is large, long, firm, and covered with thick brown scales, 
placed in an imbricate order, and furnished with many long tough 
fibres. 

This article has long been held in repute as a remedy for Taenia. 

It was known in the time of Dioscorides, and at various periods 
there have been published successful accounts of the manner of ex- 
hibiting it. It had fallen into neglect until the latter part of the last 
century, when it came into notice by being discovered to be the reme- 
dy which had become greatly celebrated in Switzerland, as a specific 
in the cure of Taenia. The secret was purchased by the King of 
France, Louis XVI., in 1775, after its efficacy had been attested upon 
trial by some of the principal physicians in France. The propietor 
of the medicine was Madame Nouffer, whose reputation was very 
great in the treatment of this complaint. 

The article of which her medicine was composed, consisted of the 
root of the male fern gathered in the autumn, and reduced to a fine 
powder. 

The manner in which it was directed to be used was the following. 

Three drachms of the powdered root are mixed with four or six 
ounces of water. The whole is to be swallowed by the patient in 
the morning on an empty stomach. For children the dose is lessened 
to a drachm of the powder. 

If the medicine produces nausea, which it is apt to occasion, the 
patient is directed to chew any thing which is agreeable, but not to 
swallow it — or to smell the fumes of vinegar. Should the medicine 
be rejected another dose must be taken as soon as the sickness is 
gone off. 

Within a few hours after a cathartic is to be exhibited, consisting 
of drastic articles, and when it has operated, the worm will usually 
be found to have been expelled. 

Such is an outline of the practice pursued by M. Nouffer and 
which had acquired much reputation. The efficacy of it is confirm- 
ed by Professor Brera, who states that he has cured seven patients 
by this remedy. The efficacy of the fern is also supported upon the 
authority of a number of ancient as well as modern writers, and seems 
fully entitled to be considered a valuable remedy in the treatment of 
this troublesome disease. 

In Dr. Chapman's Therapeutics, a case is related by Dr. Jones of 
New -York, of a lady, who after taking numerous worm medicines, 



cxcv. 

with little or no effect, drank a decoction of fern, a pint a day, until 
some gallons were consumed, when a worm came away measuring 
forty-five feet. 

The usual mode of administering the fern is in the dose of 31. to 
jiii. in water or syrup, repeated two or three mornings in succession, 
fasting, and then followed by a full dose of some active cathartic. 

It is given also in the form of extract, prepared by digesting the root 
cut small in a sufficient quantity of Sulphuric iEther. The tincture 
is then pressed, concentrated by distillation, and the aether fully 
removed. 

From a pound of the root, 3xviii. of a brownish thick extract is 
obtained. 

The extract contains not only the volatile oil of the fern, but also 
a fixed oil, tannin, acetic and gallic acids, a muco-saccharine matter, 
green and red colouring matter, and a semi-resinous substance 

Eighteen to twenty grains given at bed-time, and the same quan- 
tity in the morning fasting, destroyed Taenia, so that on the adminis- 
tration of a cathartic, the parasite was discharged, often in the form 
of a ball. Recommended by Hufeland. — Dunglisori s New Remedies. 

Oil or Spirits of Turpentine. — From observation and experience, 
the oil of Turpentine may be regarded as one of the best and most 
certain means of procuring the expulsion of this and other intestinal 
worms. 

Its good effects in diseases arising from Lumbrici, are well known, 
and the periodical Journals contain many cases of its successful ap- 
plication to the cure of Taenia. 

This worm, from the very unpleasant symptoms produced by it, 
and the difficulties which exist in its removal, may be regarded as 
among the most unpleasant affections to which the system is liable. 

The Spirits of Turpentine, from the reports in Europe and this 
country, may be considered as the most effectual means hitherto dis- 
covered for its expulsion. 

The earliest mention which is made of the medicine is by Dr. 
Bateman, in the Edinburg Journal for April, 1810, and it is stated 
that a Dr. Fenwick having discovered that the oil of Turpentine had 
been used by a mechanic, with considerable success in the expulsion 
of the Tape worm, it had been employed by several physicians in the 
public charities of London, and it appeared to be an active antidote to 
that troublesome animal in a great majority of cases. 

To be effectual, it must be given in large doses, from half an ounce 
to fi. and even fii., and its exhibition is usually followed in a few 
hours by a considerable cathartic operation, and a discharge of 
Taenia. 

The principle upon which its virtues depend, does not seem to be 
distinguished by the true cathartic character. The medicine has the 
power of resisting absolute decomposition, by the assimilating opera- 
tions of the organs of digestion, passes along the intestines in a great 



CXCV1. 

measure unchanged, and was observed by Dr. Lettsom floating upon 
the surface of an evacuation. 

The Turpentine then comes in contact with the worm, and by the 
influence of a specific property deprives it of life. By this means it 
is brought into the state of inert matter, and thereby subjected to the 
expulsive action of the organ, whose cavity is the place of its pro- 
duction, and whose function its existence disturbs. — Kennedy on In- 
testinal Worms. 

In the doses I have mentioned it does not produce any more unea- 
siness than so much gin, and it is best given in milk. It should be 
taken early in the morning and on an empty stomach. 

In a large dose it is less apt to produce uneasiness of the bladder, 
or in going to stool, than in small doses, because the medicine is car- 
ried off speedily by the bowels. 

The constitutional symptoms which follow its use, are, giddiness 
•to a great degree, as if the person was intoxicated, which comes on 
shortly after taking it, and continues for an hour or more, when it 
subsides with the cathartic operation. It is stated by Professor Brera, 
that in a few cases in which it has failed to expel the Taenia, it has 
commonly afforded great relief to the painful feelings which were be- 
lieved to originate in the presence of the worm. 

I might cite a number of cases from periodical publications of the 
beneficial effects which have been exhibited by the oil of Turpentine, 
but they would be too lengthy in detail. I shall refer you to the Ec- 
lectic Repertory — the Review of Professor Brera' s work — and the 
Medico Chirurg., Trans. Vol. II. — Journal of Foreign Medical Sci- 
ence, Vol. III. 



Carbonate or Rust of Iron. — Of the medicines for Taenia, Dr. Rush 
thought none were more safe and certain than the Rust or Carbonate 
of Iron. Taught by an old sea captain, who was cured of a Tsenia 
by this medicine, Dr. R. has given from jii. to fss. every morning for 
three or four days, not only with safety but success. Treacle or jelly 
are proper vehicles to give medicines of this- kind to children, but they 
must not be mixed with them till the moment they are to be taken, 
otherwise the vehicle will taste strongly of the metal. 



Cathartics — Have been used in a greater or less degree in this af- 
fection, and it has been said with much success. Those used have 
been of the drastic nature, and given in such doses as to produce ac- 
tive catharsis, have succeeded in expelling large portions of the Taenia. 
Of the cathartics employed, the Mercurials have been much esteemed. 
Also Jalap — Colocynth— Scammony, and Gamboge. The last article 
has had some reputation, and enters largely into the composition of 
several nostrums for Taenia. 

Werlhoff's remedy for the Tape worm was Gamboge alone. He 
used to give it morning and evening, to the extent of twenty grains, 
mixed with a little sugar and water, repeating the same the next day. 



CXCV11. 

if necessary, and even the third day. He never observed any harm 
to arise from these large doses, the patient being generally as well as 
ever the day after the exhibition of the medicine. 

Besides these, various other remedies have been emploped, as Ar- 
senic — Assafcetida — Tin. 

If the powdered Tin is preferred, the following is the mode of ad- 
ministering it. 

Powdered Tin, fiii. 

Conserve of Roses, 3iii. syr. q. s. ft. electuary. 

One to two table-spoonsful to be taken for a dose in the morning. 
The dose to be repeated for three mornings in succession. The day 
before the first dose and the day after the last dose of the medicine, 
the patient is to be purged with an infusion of Senna and Manna. 
This powder immediately cures the pain in the stomach, occasioned 
by the worm, even though it does not bring them away until some 
days after. 



Pomegranate. — The bark of 4 the root of Pomegranate has been 
recommended as a remedy for Taenia, and a number of cases stated 
as cured by its use. 

It may be given in the form of powder, viii. grs. to 3i. b. v. t. d. 

The most usual mode is in decoction, in the following manner. 
Bark of the root of Pomegranate, f ii. 
Water, 1 pint and a half, boil to 1 pint, 

f ii. are given for a dose every half hour until the worm is expelled, 
which generally occurs twelve hours after the first quantity has been 
administered. 

If the decoction is of greater strength it excites considerable nau- 
sea and griping. It also acts upon the nervous system, producing 
vertigo, tremblings, and the sensation of intoxication, with other 
symptoms indicative of a poisonous quality in the bark. 

The experiment has been made of placing living Taenia in a decoc- 
tion of the bark, and it was observed that the instant they were 
plunged in these preparations they writhed, and otherwise manifested 
great pain and died in the space of five minutes. That their death 
in these cases arose from the influence of the bark is evident, as these 
worms live several hours after expulsion, when kept in plain tepid 
water. 

In the treatment of worms we must not confine our attention to 
the mere expulsion of the worm, but endeavor to give tone to the 
stomach and bowels, by the use of tonics, so as to prevent their re- 
production. 



Besides the worms mentioned, there are several others to be found 
in other structures and cavities of the body. 

1. Filaria Medinensis or Guinea worm, found in the cellular tissue, 



below the integuments. 



CXCV111. 

2. Hamularia sub-compressa, found in the bronchial glands. 

3. Strongylus gigas, found in the kidneys. 

4. Distoma Hepaticum, or liver fluke, found in the gall bladder, 
and in the human liver. 

5. Polystoma Pinguicola, found in the fat which covers the ovary. 

6. Cysticercus Cellulosus, found in the cellular tissue of tTie mus- 
cles and brain, especially in the choroid plexus, where they have been 
met with in considerable numbers. 

7. Echinococcus, the hydatid, found in various parts of the body. 



Division V. 

ANTACIDS 



Division VI. 

Medicines which promote particular secretions. 

DIAPHORETICS. 

Before I proceed to consider the manner in which this class of 
medicines increase deficient perspiration, it may be useful and inter- 
esting to give some account of the secretion in a healthy state. Of 
all the natural evacuations none are so important, or so extensive, and 
none free the body from so many impurities as the function in question. 

Perspiration is a subtle, invisible vapour, continually flying off 
from the surface of the body, though ever so well protected by clothes, 
and is found to contain several excrementitious substances. For the 
discovery of the nature, importance, and extent of perspiration, we 
are indebted to the celebrated Physician Sanctorius, who established, 
by the labour of thirty years, the existence of this discharge beyond 
the possibility of doubt, and whose doctrines have since been sanc- 
tioned by the experiments, and supported by the authority, of many 
able men. 

It appears that a considerable discharge takes place habitually 
from the skin though in a form not perceptible to our senses. This 
has been called insensible perspiration, and it may be demonstrated 
by holding a highly polished metallic surface to the skin, when a 
watery vapour collects upon it and clouds it. Under ordinary cir- 
cumstances the whole discharge is evaporated, and passes off in this 
invisible form. 

When this secretion is increased by any cause, as by violent exer- 
cise, it becomes sensible perspiration and is commonly denominated 
sweat. This, as I have observed, is only an increased quantity of 
the same kind of fluid, as the insensible perspiration, very small par- 
ticles are observed on the skin, and they unite into larger drops. 



CXC1X. 

Heat, as it is the most powerful means of exciting the action of 
the heart and arteries on which this phenomenon depends, is the most 
common cause of sweating : strong bodily exercise, warm food, and 
other causes produce the same effect. 

The quantity of the cutaneous discharge cannot be easily ascer- 
tained, but it may be supposed to be very great, as it is constantly 
going off through innumerable pores every where spread over the 
surface of the skin. 

When to this we add the extent of the exhaling organ, and the 
quickness with which we can see the perspiration produced, we shall 
expect to find the discharge very considerable. Sanctorius has com- 
puted its quantity, in the warm climate of Italy, to be equal to five- 
eighths of the substances taken. In this estimate he has not been 
followed by other experimenters, and it seems probable that it va- 
ries according to the temperature of the climate. In other climates 
as in England, Ireland, and' even South-Carolina, according to the 
experiments of Dr. Lining, the quantity of urine is greater, and of 
course less is discharged by the skin. 

We may be safe in stating, that in a person of middle stature, and 
in perfect health, the quantity of perspiration will vary from three to 
four, and even five pounds in the twenty-four hours. 

The importance of this secretion may be judged of from the 
uneasy feelings produced by its suppression, and from the number of 
diseases which originate in, or are aggravated by an interruption of its 
free discharge. 

A few words upon the nature of this secretion will close what 
I have to say upon this subject. 

From the very insensible manner in which it escapes from the skin, 
there is some difficulty in collecting it in sufficient quantity for ex- 
amination. It seems to be in a great measure aqueous, holding in 
solution several salts, the excrementitious matter of animal substances, 
and sometimes acids. It possesses sensible properties, causing the 
peculiar odour of the body, which is very remarkable in particular 
individuals, and possessing peculiar characters in some races of man- 
kind. 

Having premised these observations, I shall enter upon the consid- 
eration of Diaphoretics. 

The medicines of this class increase the deficient discharge by the 
skin, whether in the form of insensible perspiration or by sweating. 

In the common language of writers, the term Diaphoretic is ap- 
plied to those medicines only which promote the insensible perspira- 
tion, or the slightest degree of moisture in the skin, and those which 
occasion sweating, they distinguish by the term sudorific. 

But as in the medicines arranged by authors under these titles, we 
can find no difference, except in the degree of activity, or what arises 
from the manner of administration, we may comprehend the whole 
under the title of Diaphoretics. 

The action of Diaphoretics may be arranged under three heads, 



cc. 

1st. Those which operate by exciting 1 the action of the heart and 
arteries. 

2d. Those which operate by producing a relaxation of the cuta- 
neous vessels. 

3d. Those which are local in their operation, or wtroh are applied 
to the surface of the body. 

Diaphoretics produce their effects in the first plac , by increasing 
the general force of the circulation. 

By this means the blood is propelled more forcibly into the minute 
vessels, and the secretory process is thereby promoted. Under this 
head are included all the stimulating Diaphoretics, and they appear 
to produce their good effects by evacuating the watery part of the 
blood, and lessening the quantity in the circulating system, thereby 
acting as depleting remedies. They also fulfil other indications, for 
by determining the blood from the internal parts to the surface, they 
relieve local congestions, remove the spasmodic structure of the cu- 
taneous vessels, and render the skin moist and relaxed. 

Although, " every stimulant, may, under certain circumstances, 
produce sweating, simply by increasing the action of the heart and 
arteries, yet it must not be supposed that the stimulating Diaphoretics 
act solely by giving a general increase of momentum to the blood, 
since many of these remedies undoubtedly possess a peculiar tenden- 
cy, not only to determine the circulation to the surface, but also 
particularly to excite the activity of the perspiratory vessels."-JE6erZe. 



37 * 

ble, that it does vary according to the temperature of the climate. In 
other places, as England, Ireland, and even South-Carolina, according 
to the experiments of Dr. Lining, the quantity of urine is greater, and of 
course less is discharged by the skin. It may with safety be stated, 
that in a person of middle stature, and in perfect health, the quantity of 
perspiration w' 1 v?rv from three to four, and even five pounds in the 
twenty-four h' 

The importance of this secretion may be judged of from the uneasy 
feelings produced by its suppression, and from the number of diseases 
which originate in, or are aggravated by an interruption of its free dis- 
charge. The nature of this secretion. 

Of the means by which it is excited — 1. Agents which increase vas- 
cular action. 2. Agents which relax the cutaneous vessels. 3. Agents 
applied to the surface. Remarks upon these divisions, and the circum- 
stances under which they become useful and proper. Efficacy of these 
articles improved by their union. 

As it is of importance in many diseases to produce Diaphoresis, some 
rules may be laid down for their exhibition, and for these I am partly in- 
debted to Dr. Chapman's Therapeutics. 

Rule I. During the exhibition of Diaphoretic medicines, it is most 
beneficial that the patient be confined to bed, and in some instances it is 
essentially necessary. 

Rule II. The pulse and temperature of the skin, are to be carefully 
watched. If the pulse be active, or the heat very great, Diaphoresis 
cannot be induced until they have been lowered by vense section or 
other depletions, which should not be omitted unless contra-indicated. 
This rule is of the utmost importance, since diaphoresis can never be 
advantageously excited until the inflammatory action of the system has 
been reduced. The medicines of this class are, let it be understood, se- 
condary remedies, and are resorted to when more vigorous means 
have failed, or cannot further be persisted in to subdue disease. When 
employed at a proper period they are of the utmost benefit, since they 
not only act as evacuants, but by determining the fluids to the capillaries 
they relieve the larger vessels. The strength of their impression will be 
adapted to the existing action, which they may change or subdue, while 
they will be wholly inefficient at an earlier period. 

Rule III. While under the operation of a Diaphoretic, diluent drinks 
must be employed, unless the stomach be very irritable, or unless the an- 
timonials have been exhibited, for in either case they may induce vomi- 
ting. The temperature of the drinks must depend upon that of the sur- 
face, for if the skin is very hot cold drinks are preferable, if the skin is 
cold and the system feeble warm drinks are to be preferred. 

Rule IV. After the perspiration has subsided, the patient's linen 
should be changed, and he should be removed to a dry bed, or a dry part 
of the bed. The clothes under such circumstances become highly of- 
fensive, and in addition tend much to check the perspiratory process. 

Rule V. Guard against a sudden suppression of perspiration. This 
rule is of great importance, whence it is often necessary to watch pa- 
tients while asleep. I have more than once known relapses to take 






38 

place from this cause, which had very near proved fatal. One instance 
in particular occurs to my mind, in which a female labouring under a 
Pulmonary affection, had her symptoms suddenly aggravated by the bed- 
clothes falling off when asleep, and while perspiring freely. 

Rule VI. Avoid Cathartics during the administration of Diaphoret- 
ics, for it may suppress perspiration by a revulsive action, and will render 
necessary a frequent exposure to cold. 

Rule VII. Avoid during the use of Diaphoretics those medicines 
which increase the secretion by the kidneys. These last directions are 
but little considered in ordinary practice, it being very common to hear 
of medicines being directed with a view to a cathartic and diaphoretic 
operation, or a diuretic and diaphoretic action. Physicians too often 
flatter themselves, that they can accomplish more than is compatible with 
the laws of the animal economy. The functions to which I have refer- 
ence, are always opposed to each other — whatever will excite one will 
diminish the other. 

Rule VIII. When long continued perspiration is requisite, as in 
chronic rheumatism, flannel should be substituted for linen next the skin ; 
without this it will be impossible to keep up a uniform and constant per- 
spiiation. 

Application of Diaphoretics to diseases — In Intermittent, Remittent 
and Continued Fevers — In affections of the bowels — In Catarrhs and 
Pulmonary diseases — In Rheumatism, Dropsies, &c. 

Particular Diaphoretics, and such as increase arterial action. 

Family Papaveracece — Papaver Somniferum — Poppy. Effects of 
Opium upon the nervous und vascular systems. The diaphoretic pro- 
perty of opium, is intimately connected with the power it possesses, of 
stimulating the action of the heart and arteries, and that in a manner cor- 
responding in its effects with other stimulants upon the healthy body. 
That opium is stimulating, is evinced iu its producing vigour of body 
and cheerfulness of mind, in its exciting passion and emotion, in inducing 
watchfulness, dissipating sadness, and inspiring resolution. When taken 
in immoderate doses, occasioning giddiness, imperfect speech, full pulse 
quick breathing, nausea, vomiting, convulsions, and death — in all these 
respects it is strongly allied to other articles, which are indisputably 
stimulant. 

The influence of opium is particularly exhibited on occasions where 
great mental exertion is required. 

To these, we must add the practice of taking opium, so common 
among the Persians and Turks. 

If we examine the effects of opium in certain diseases, we shall find 
new proofs of its stimulating qualities. Do we not see it recommended 
every day in those of the greatest debility ? 

To obtain its diaphoretic operation it is seldom employed alone, but is 
combined with various articles — as the Antimonial preparations — Ipe. 
cacuanha — Calomel. These combinations useful in Inflammatory dis- 
eases after depleting measures have been freely pursued. Under these 
circumstances, symptoms of irritation often succeed, which symptoms 



39 

are relieved by opium, and with peculiar good effects when united with 
the above — combined with calomel particularly, an anti-inflammatory 
operation is exerted. 

Dose 1 gr. 

Family Lanrinea — Laurus Camphora. Camphor is obtained from 
two species of trees. The one called Laurus Camphora, a large forest 
tree, which grows wild in the islands of Borneo and Sumatra. Every 
part of the tree gives out a strong smell of Camphor, and the wood is 
much sought after as a material for chests, drawers, &c. — because its 
peculiarly aromatic smell, renders it impenetrable to ants and other des- 
tructive insects. The oldest trees are the best, and the camphor is 
found in perpendicular veins, near the centre of the tree, or concreted 
in the knots of the wood. 

Method pursued by the natives to separate the camphor from the trunk 
and branches of the tree. 

The other species of Laurus which yields camphor grows in Japan, 
but does not afford the article so plentifully, nor so good as the first. 

Camphor is also obtained from a tree of another genus, the Dryobala- 
nops Camphora, which grows to a great height in the forests on the 
coast of Sumatra. 

In the state in which it is imported into Europe, it is impure. It is 
of a greyish colour, in small grains, contains much dust, and foreign 
substances. It is refined before being used. The process consists in 
uniting thirty to fifty parts of quick-lime with the impure camphor, 
and submitting the mixture to sublimation. 

Camphor is obtained from various aromatic plants and essential oils. 
Differs from that obtained from the Laurus Camphora — Qualities, and 
operation of this article on the system. In its operation on the system, 
this article is somewhat peculiar. In its sensible properties it is, doubt- 
less, stimulant, but it appears to exert but little action on the pulse. It 
soon produces a strong tendency to perspiration, without the pulse being 
sensibly affected in quickness. On this account in Febrile affections, 
accompanied with a dry contracted skin, it is often employed with other 
articles, even when the excitement would seem to forbid it. 

United with Tartarised Antimony, and Calomel, a speedy and effec- 
tual relaxation of the skin takes place, with copious perspiration. In 
place of Calomel the Nitrate of Potash may be substituted, and good 
effects will often result — Vide Formula. Opium united with camphor, 
has its diaphoretic operation increased, while the disagreeable conse- 
quences which so often follow the use of the former, in some constitu- 
tions, are obviated. 

German or Camphor practice in the treatment of Cholera. 

Exhibition of Camphor — Formula. 
Dose ij to viii grs. 

The effects of Camphor in a very large dose — 3iito ^iii detailed. 

Carbonate of Ammonia. Preparation. It is formed by the double 
decomposition which takes place from the union of Muriate of Ammo- 
nia and Carbonate of Lime — the carbonic acid uniting with the ammo- 
nia and the muriatic acid with the lime — muriate of lime being formed 



40 

and remaining in the retort, while the carbonate of ammonia passes 
over and concretes on the sides of the receiver. Properties. 

Seldom employed in this state as a diaphoretic : but united to vinegar, 
whereby an acetate of ammonia is formed and held in solution, it is 
of much utility, and may be beneficially employed when required as a 
diaphoretic and febrifuge — Employed in fevers generally with this ad- 
vantage, that it will often be retained on the stomach when most others 
would be rejected. 

Dose f ss every hour. 

Family Synantherece — Eupatorium Perfoliatum — Thoroughwort — In- 
digenous — Natural History — Properties — Employed as a diaphoretic in 
fevers in the form of infusion. 

3ii to | ss in a quart of boiling water. Dose fss to f ii 

Family Apocyneoe — Asclepias Decumbens — Pleurisy Root — Indige- 
nous — Natural History — Employed in diseases of the pulmonary sys- 
tem — Promoting expectoration — relieving the breathing, &c. Given in 
the form of an infusion. • 

fss of the root to 1 qt. water. Dose, a tea-cup full. 

Family Aristolochice, Aristolochia Serpentaria — Virginia Snakeroot — 
Indigenous — Natural History — Properties — Employed in the advanced 
stages of fever, attended with Typhoid symptoms, alone, or in combina- 
tion. Formula. 

31 to 3ii in a pint of boiling water. Dose f i. 

Asarum Virginicum — Heart Snake Root. Indigenous. Natural 
History. Employed as the preceding. 

Asarum Canadense, or Wild Ginger — Indigenous. Natural History. 
Employed as the preceding. 

Family Araliacece, — Aralia Spinosa — Prickly Ash — Indigenous — Na- 
tural History. Employed in Rheumatism, and in the formation of Diet 
Drinks. 

f i of the bark of the root to 1 pint spirits. Dose ^i to 
^ss repeated. 

Vegetable Alteratives. 

Family Rutacea — Guaiacum Officinale. Natural History. The 
tree from which the gummi resinous substance so commonly met with, is 
obtained, is a native of South America, and the West-India islands, and 
grows to a considerable size. The wood is extremely ponderous and 
solid, very resinous, of a blackish yellow in the middle, and of a hot aro- 
matic taste. From its possessing the properties of the gum resin, though 
in a less degree, it has been employed in medicine, and as an ingredi- 
ent in decoctions and diet drinks, which were at one time much celebra- 
ted in several diseases of the system, particularly in syphilitic affections. 
It yields in its efficacy to the extract or gum. 

The Gum Guaiac is obtained by wounding the bark of the above tree, 
from which it exudes in a considerable degree, and when a sufficient 
quantity has been discharged and hardened by exposure to the sun, it is 
gathered and packed in small kegs for exportation. Properties. 



41 

Medical Uses. The Guaiac was Originally introduced into Europe 
from its supposed efficacy in curing Lues Venerea. For some time it 
continued to be employed as the chief remedy, and it is difficult to reject 
the testimony of its efficacy in curing these complaints. It is not em- 
ployed at the present time in the treatment of this disease in the early 
stages, but in what is called the sequelae of the disease, it will be found 
very useful. It rarely happens that it is employed alone, but combined 
with other alteratives in the manner which will be detailed. It is also 
employed advantageously in Chronic Rheumatism, and in Cutaneous dis- 
eases. In Dysmenorrhcea — In Rheumatism, &c. — Formula. Forms of 
administration. 

Decoction of the wood prepared by boiling fi to fii of the shavings in 
rbiii of water, reduced to ibii — a pint or more to be taken daily in 
divided doses. 

Gum Resin administered in the form of powder — grs. x to 3ss 
, Tincture 311 to 3vj 

Family ThymelecB — Daphne Mezereon — Natural History. Posses- 
sing similar properties with the preceding article, it has been employed 
in the same diseases. It is not trusted to alone, but is combined with 
other alteratives. 

Family Asparaginece — Smilax Sarsaparilla — Natural History — Pro- 
perties. This article was brought into Europe so late as the year 1530, 
with the character of being a specific for Lues Venerea, in which 
disease it had been employed by the Indians with considerable success. 
It has fluctuated much, in the opinion of Medical men, and at the pres- 
ent time its real virtues are better known and appreciated. 

In proceeding to speak of this article, I would observe that the re- 
marks made, will not have reference to the Sarsaparilla alone, but they 
must be understood as applying to it in its various states of combination. 
By itself, it is highly useful, but the good effects derived from this and 
other similar articles, as the guaiacum — mezereon — sassafras, &c. are 
greatly increased by combination with each other. It is therefore of the 
combinations of this article, contributing as they do, to their increased 
activity, as well as to the greater convenience of administration, that 
the practical remarks I shall make, will apply. 

Sarsaparilla and its combinations are admirably adapted to the secon- 
dary stages of Syphilis. The secondary forms of this disease exhibit 
themselves in the most painful, .loathsome, and mortifying affections of 
the human body. Originating as these diseases do, not in single acts of 
folly, or the weakness to which human nature is subjected, but in a con- 
tinuance of excesses, dissipation, and disease, those who are subject to 
them, exhibit most frequently in constitution and appearance, a body 
impaired in its energies, crippled in its faculties. Mercury, alone, in 
a constitution like the one I have described, cannot be endured. Its 
stimulating, or rather irritating operation, under these circumstances, 
aggravates all the symptoms — harrasses the patient, and superinduces 
the most distressing consequences. Sarsaparilla, and the vegetable 
alteratives, combined with very minute quantities of the per Chloride of 
Mercury, in the manner I shall point out, forms a preparation freed 
6 



;. , • '42 

from the objections just made, and a medicine well adapted to the dis- 
ordered states of the constitution, now under consideration. It will be 
found excellent in restoring the appetite, strength, and flesh of the pa- 
tient. 

It will complete the cure of ulcerations of the palate, throat, and mu- 
cous membrane of the nose — skin, and other parts. It will relieve noc- 
turnal pains of the limbs, painful enlargements of the joints — of the 
bones, membraneous nodes, cutaneous ulcerations, &c. 

It will efface the blotches, foul spots, stains, &c. which in a constitu- 
tion of this character so frequently occur from slight irritations, or which 
remain after the ulcerations have healed. 

It wili remove that morbid condition of the solids and fluids, which 
disposes every injury, however slight, to degenerate into a festering, 
painful, scabby ulcer. 

It will, in short, so improve the digestive and assimilating operations 
of the system, that a more healthy blood and more renewed fibre will be 
substituted for the defective conditions of the one and the other, and thus 
fully support the character bestowed on these medicines, of being essen- 
tially alterative. To accomplish these objects, this class of medicines 
must frequently be long and perseveringly employed. It cannot be sup- 
posed that these great and important designs can be effected with a few 
or lengthened repetitions of these substances. To their continued use, 
occasionally other alteratives should be added — as diet, change of cli- 
mate, a long sea voyage, travelling. 

Sarsaparilla, and its combinations, will be found useful, not only in 
what is called syphilitic rheumatism, but the chronic forms of ordinary 
rheumatism. 

It will be found useful in various affections of the skin, pustular, papil- 
lary, herpetic. Under the last, I would consider not only the affections 
properly so called, but that very troublesome disease Taenia capitis, 
which, when long existing, refuses to yield to local remedies, and requires 
the aid of such as are constitutional. 

The combinations of which 1 am speaking, will be found useful in 
the chronic ulcerations, of such frequent occurrence in the laboring and 
poorer classes of society. The tonic and alterative impressions excited, 
contribute to the rapid and sucsessful operations of granulation and cica- 
trization. From the remarks I have made upon these articles, you will 
be convinced that I repose no small confidence in their virtues — and 
with the opportunities I have had of prescribing them, in constitutions 
impaired and debilitated from diseases and excesses of various kinds, in 
habits vitiated from a scrofulous or venereal taint, or from the injudi- 
cious use of Mercury ; the relief which, in many instances, has been af- 
forded, fully entitles them to these commendations. I might say more, 
but I shall probably be charged with extravagance. I trust I have said 
sufficient to direct your attention to their virtues and efficacy. 

Preparations of this article. Sarsaparilla yields its virtues very readily 
to boiling water, but that the whole of its active and extractive matter be 
obtained, it is necessary that the boiling be continued a considerable 



43 

time and in a close vessel. The preparations which are, or have been, 
in vogue, are the Simple Decoction — Compound Decoction — Syrups, 
and Extracts. 

Simple Decoction prepared by boiling. 
^ ij of the roots in four pints of water four hours, in a 
vessel lightly covered and placed near the fire ; then 
taking out the roots, bruising them, returning them 
again into the liquor ; macerate in a similar manner 
for two hours more, and boil to two pints and a half — 
strain. Dose, 1 pint daily. 

The Compound Decoctions are prepared by combining with the sar- 
saparilla other articles, as the shavings of the wood of guaiac, bark of 
sassafras, liquorice root, bark of mezereon root — water. This is the 
Lisbon diet drink, and for the proportions and manner of preparing, I 
refer you to the Dispensatories. 

A preparation superior to the Lisbon diet drink, is the following — Vide 
Formulae. 

These preparations though valuable, will not be persisted in by the pa- 
tient for any length of time. From the delicacy of the stomach, or the 
captiousness of the invalid, large and repeated draughts of these medi- 
cines will not be taken. That the remedy may be persisted in, it be- 
comes necessary to present it in a more agreeable form. This is done 
by increasing the quantities of the ingredients, continuing the decoction 
longer, forming a fluid extract, and combining sugar and treacle so as 
to form a syrup. 

The first preparation introduced into general notice under this head, 
was that prepared by Swaim, and called Swaim's Panacea. There can 
be no doubt that it is a preparation of sarsaparilla, with other of the 
vegetable alteratives, reduced to a concentrated state by boiling. When 
thus reduced, treacle or sugar is added, and a syrup formed. In this 
preparation some advance has been made, and to the vegetable, the 
mineral alteratives have been added. The mercurial preparation used, 
is the Perchloride of Mercury or Corrosive Sublimate. This article 
may have been selected from its activity, the smallness of the quantity 
required, the difficulty of detection, and its seldom salivating. The 
union of these articles, has placed us in possession of a preparation, 
more active, more agreeable to the taste, and more convenient for ad- 
ministration. I shall not recommend to you the use of this medicine 
for several reasons, and because with a little industry you can be posses- 
sed of a preparation free from all objections, and with the operation of 
which in the diseases I have mentioned, you will be well pleased — Vide 
Formulae. 

Other preparations of sarsaparilla are simple fluid extracts, and 
compound fluid extract. By the agency of steam the active mat- 
ter of this, and other articles has been concentrated, in a very great de- 
gree, and very neat and useful preparations furnished. 

Sarsaparilla Syrup. 

An alkaline principle has been obtained from this root, to which the 
term Parillina, or Sarsaparilline, has been given. 



44 

In selecting the roots, it will be right to choose such as are plump, not 
carious, or too dusty on breaking, and which split easily longitudinally. 

Substitutes for Sarsaparilla. 

Family Asparagince— Smilax Herbacea — Indigenous. 
Smilax Pseudo China— or China Briar — Indigenous — Natural History. 
The root cut into small pieces is much employed in decoctions and diet 
drinks. It is possessed of some acrid properties, and on this account it 
often acts as an emetic when the decoction is too strong. I have em- 
ployed it very frequently. 

Family Ulmacece — UlmusFulva — Slippery Elm — Indigenous — Natu- 
ral History. The bark of the tree, and of the branches employed. It 
is given in the form of a decoction, prepared as directed in the Formulae. 

The decoction when properly prepared, is of a clear brown colour, 
not unpleasant to the taste, and contains a considerable proportion of 
amylaceous and mucilaginous matter. 

Administered in the quantity of a pint a day, it appears to increase 
the insensible perspiration, to restore the appetite, improve the tone and 
powers of the digestive organs, and to strengthen and invigorate the 
general system. 

[b] Diaphoretics which produce psrspiration by relaxing the cu- 
taneous vessels. 

Aniimonial Preparations — Tartarised Antimony. Promotes the ex- 
cretions. This property supposed to be connected with the production 
of nausea — Nausea not essential, but perspiration is the result of a di- 
rect and specific action upon the vessels of the skin ; to this must be ad- 
ded its sedative and febrifuge operation, properties which particularly 
adapt it to the excited stages of disease — Combinations. Formula. 
Dose, 1-6 gr. 

Pulvis Antimonialis. It is prepared by calcining together, equal 
weights of sulphuret of antimony, and hartshorn shavings, until the 
matter becomes of a white colour, forming a protoxyde of antimony 
with phospate of lime. It is frequently an inert article, from careless, 
ness in the preparation. Its inertness is owing to the following circum- 
stances : 

1. To the Peroxide of Antimony being formed instead of the Protox- 
ide. The Peroxide is comparatively inert, requiring to be given in 
larger doses, to produce the same effects which result from small doses 
of the Protoxide. 

2. In the second place, it may contain a large portion of the Phos- 
phate of Lime combined with it, which also is an inactive substance. 

Employed in febrile and inflammatory affections — in determinations 
to the head ; and when the article has been properly prepared is decided- 
ly useful. 

Dose, iij to v grs. 

Kermes Mineral and Golden Sulphuret of Antimony— Preparation 

Of more uniform strength and equal activity. 
Dose, ii to v grs. 



45 

Ipecacuanha — Diaphoretic — In small doses useful in Catarrhal and 
Pulmonic Affections — diminishing the mucous secretion in some cases, 
and in others exciting it when deficient; useful in other increased dis- 
charges from the mucous membrane, as in diarrhoea and dysentery. — 
Given in small doses alone, or combined with opium and the sulphate of 
potash, as in the Dovers Powder. 
Dose, ss to ij grs. 
Dovers Powder, v to x grs. 

Nitrate of Potash — Saltpetre — found native and prepared artificially — 
Properties: to increase its powers, usually combined — as with Tartari- 
sed Antimony, or Tartarised Ant: and Calomel, forming the Nitrous 
and Antimonial Powders — Formula. The Crystals of this Salt some- 
times mistaken for Glauber Salts — Effects of a large dose — Symptoms — 
Treatment. 

Crystals of other articles, which may be mistaken for each other ; 
Sulphate of Zinc for Sulphate of Magnesia ; and the last, for the crys- 
tals of Oxalic Acid ; Antidotes of Oxalic Acid — Lime — Magnesia — form- 
ing an insoluble Oxalate of Lime. 

Carbonates of Soda and Potash — Given in the form of Neutral mix- 
ture and effervescing draught — Formula. 

Soda Powders. 

[c] Agents applied to the Surface. 

Regulated by the condition of the skin — When excited, cool air, cold 
applications, sponging with spirits, vinegar, &c. 

Cold Bath. 

Effects of cold water when applied to the excited surface. The ner- 
vous system experiences a great and sudden impression — Vascular ac- 
tion is diminished — Morbid heat reduced — the cooling process of perspi- 
ration instituted. Employed in febrile diseases when there is no sense 
of chilliness present — when the heat of the surface is steadily above 
what is natural — and when there is no general or profuse sensible perspi- 
ration. Manner of employing the Bath. The most salutary conse- 
quence which follows the proper use of this powerful remedy, is the 
production of a profuse and general perspiration, and this is the result 
partly of the sudden reduction of animal heal to its natural standard, but 
principally of the great reduction produced throughout the whole of the 
circulating system, by means of the violence of the shock. Jt is this 
circumstance that appears to give so much advantage to a general effu- 
sion of cold water, in fevers, in preference to any partial application. 
The application of cold in any way to the skin during the hot stage, 
whilst it diminishes the animal temperature, takes off the parching thirst, 
lessens the hurried beat of the pulse, and renders it slow, full and regu- 
lar. It likewise removes that restlessness, and wandering of ideas, which 
precede a complete delirium, and occasions a sound and easy sleep. 
Various instances are to be found in the records of medicine, of persons 



46 

when under the delirium of fever,having thrown themselves into cold water, 
in almost all of which it is mentioned as very extraordinary, that the 
patients when taken up were perfectly in their senses, and speedily recov- 
ered from their disorder. Of these cases a great number have occur- 
red at sea, where it is evident accidents of this kind are most likely to 
happen. From what has been said, the explanation is very easy, and 
the remedy may be considered a very natural one. In acute fever, 
therefore, the object of the cold bath is to lessen the heat of the body, 
to bring on universal perspiration, to diminish action in the circulating 
system, and thereby to occasion a state of repose of body and mind, 
and sound sleep. These objects are fully accomplished in the hot 
stage of our Yellow Fever, of the Bilious Remittent or Country Fever, 
of Intermittents, of simple Continued Fevers, &c, in all of which I have 
employed the bath with the most gratifying effects. 

The period for using the bath, should not be the very first paroxysm 
of fever ; but after depleting remedies have been employed, without di- 
minishing the action of the system, when from their continuance they 
threaten dangerous consequences, or are not likely to yield to the ordi- 
nary modes of treatment ; then the bath is to be resorted to. Hence, 
therefore, every case of fever will not require it, for in the majority of 
them, our usual remedies are capable of making an impression. It is 
only in the more inveterate fevers, such as by their violence threaten dis- 
organization, or the derangement of parts upon which they fall, that the 
most powerful remedies must be brought to our assistance. Used with 
the precautions I have mentioned, the bath is perfectly safe, and will be 
found efficacious in subduing excitement for a time. 

When the paroxysm returns, or the excitement is renewed, it is again 
to be resorted to ; but in the meantime such remedies as the case requires 
are to be pursued, and our forces thus combined will often be successful, 
and that, too, speedily. 

One of the advantages of the bath is, that it does not interfere with 
any plan of treatment, and in many instances it will promote their ope- 
ration. The common impression that cold drinks and cold applications 
are inadmissible during the use of mercury, is highly erroneous, and 
when this medicine is employed with a view to excite ptyalism in fevers, 
the bath will be found an excellent adjuvant. It lowers and subdues ac- 
tion, and so far renders the system more susceptible of the mercurial im- 
pression. 

Improper in Febrile affections with determinations to the lungs or 
limbs — but employed with great advantage when the head is affected. 
In the latter case, when general effusion may not be deemed proper, the 
utmost benefit will be experienced b} r pouring water from a small height 
upon the head for five or ten minutes. 

The skin being in an opposite condition, and the functions of the sys- 
tem feeble — Tepid and Warm Bath. 

These terms are applied to water varying from 85 to 96 and 98° 
Fahrenheit. 

The warm bath, from its stimulating operation upon the vessels of the 



47 

skin, has a peculiar tendency to alleviate any local irritation, to remove 
morbid congestions of the circulating fluids, and therefore to be more pe- 
culiarly applicable to the advanced stages of fever, when in addition to 
the impaired condition of the vital energies, there is added accumulation 
of fluids upon particular organs. It is applicable to weak and irritable 
constitutions, which the shock produced by the cold immersion would 
overpower, and which have not sufficient vigour of circulation for an ade- 
quate reaction. By the relaxation it produces perspiration is excited, 
and hence it is U6ed with impunity in cases where the animal heat is al- 
ready too high. Diseases in which it is applicable. 

Vapour Bath. 

It consists of a chamber into which the steam of boiling water, either 
simple or medicated, is conveyed through pipes from a common digester, 
or steam boiler. The patient is seated on a chair, and the vapour ascends 
through a perforated plate at the bottom, which soon envelopes the body, 
and is taken into the lungs. 

In this apparatus the stimulant power of heat is modified and tempered 
by the moisture united with it. Its heating effect is further diminished 
by the copious perspiration which ensues. 

Utility of this application in several diseases. 

Jenning's Instrument described. 

Minor Means. 

Division VI. 

DIURETICS. 

Medicines which promote the secretion of Urine. 

This is effected by such substances as are known to exert an action 
upon the kidneys. Their office in health seems to be, to relieve the 
vascular system from any distension, from too large a quantity of fluids 
being carried into it, as well as to convey through the urinary passages, 
such fluids as having served the purposes of the animal economy, have, 
become useless. In disease these happy arrangements are broken up, 
and in some diseases, particularly in those in which swellings occur in 
various parts of the body, the^superfluous fluids instead of being carried 
off by the natural passages, become effused in the several cavities of 
the body. It becomes therefore desirable, that we should be informed, 
how these organs may be stimulated to a new and more active secre- 
tion, in order that these depositions may be removed, and the gland res- 
tored to a more healthy state. The secretion of urine is promoted in seve- 
ral ways. 

1. By increasing the quantity of water in the mass of blood. Under 
this head it may be observed, that if much fluid is taken into the stom- 
ach, and thence into the mass of blood, it must necessarily pass off by 
one of the excretories of the body, as the skin, or kidneys, and we com- 
monly find, that an increase in the quantity of drink, is attended with a 



proportional increase in the quantity of urine secreted — accordingly this 
increase of drink has always been considered the chief of diuretics. 

There are certain states of the body, in which it may be doubtful, 
whether this means of increasing the secretion of urine, can be safely 
employed, as in the well known disease Dropsy. 

Much has been said in favour of the practice, and cases related of 
cures being effected by strict abstinence. Others again condemn this 
course, and among them, the testimony of Dr. Cullen is very decisive. 
It is a practice very difficult to enforce, for in few diseases is the demand 
for drink more urgent. 

The utility of drinks in Dropsy, is fully supported by experience, and 
b) r authority, and we must consider it a fortunate circumstance, that what 
is so useful, corresponds also with the desires of the patient. 

2. The second mode of increasing the action of the kidneys is, by in- 
troducing into the system such articles as are stimulatiug to them. The 
manner in which this division operates, is more easily understood, as 
in this way we may suppose a direct application is made to the secreting 
vessels of the urine, and that thereby action is excited, and a more copi- 
ous discharge produced. Most of the saline diuretics operate in this 
manner. They are received into the circulating mass, are brought to 
the kidneys in the course of the circulation, and a larger quantity of 
fluid is secreted. Nitrate of Potash, and the fixed alkalies are of this 
nature, and the various preparations of them, as the Acetate, Bi Tar- 
trate, Carbonate, &c. 

Some vegetable substances, as turpentine, garlic, &c, pursue the 
same course, and experience proves, they produce the same results. 

3. The third mode in which diuretics operate, is by increasing the ac- 
tion of the absorbents. This is no doubt effected by the impression of 
a class of medicines upon the stomach, and by this impression nausea 
and diminished action of the arterial system takes place. It would ap- 
pear that these systems act in an inverse ratio, so that whatever dimin- 
ishes one, is followed by augmentation in the functions of the other. 
Squill, Digitalis, and Tobacco, are of this class. There is no proof 
that they are taken into the system, and they operate very peculiarly 
upon the stomach. 

The action of the absorbents is increased by medicines which pro- 
duce a cathartic impression upon the bowels, by increasing the action of 
the exhalents directly, and that of the absorbents indirectly. Hydra- 
gogue cathartics are of this character. 

The action of the absorbents is increased, and diuresis produced by 
medicines which increase the tone of the body in general. When drop- 
sy is the consequence of debility, as after fevers, &c, any tonic, or even 
nourishing diet, may have diuretic effects. 

The action of the absorbents is increased by medicines which exert a 
stimulant impression upon the system. Of this description is mercury, 
and other stimulants, which, seem to do good, by exciting the action of 
the different excretory organs, as the skin, the bowels, the kidneys. 

After all, however, that has been said, many of this class are very in- 
efficacious, and it is the common imperfection of the whole, to be very 



49 

uncertain in their operation. Sometimes the more feeble will succeed, 
when the stronger have failed, and often after every variety of kind and 
combination has been tried, the secretion of urine remains unaltered. 

Diseases in which Diuretics are used. 

Employed principally in Dropsy, in nepritic and calculous affections, 
in Gonorrhea. In chronic affections of the lungs, as asthma, dyspncea, 
chronic catarrhs, &c, diuretics afford relief. 

To ensure to this class greater certainty, I will subjoin a few rules, 
which may be important in their application. — 

Rule I. The diuretic effect of articles generally, cannot be obtained, 
should they produce any disturbance of the bowels, the cathartic and diu- 
retic action of medicines being opposed to each other. 

Rule II. In the administration of diuretic medicines, it is equally ne- 
cessary to attend to the state of the skin. If during their administra- 
tion these vessels are excited by external warmth, their action is diver- 
ted from the urinary organs to the exhalents on the surfacp, and occa- 
sions diaphoresis. To produce a diuretic effect, the surface should be 
kept cool. 

Rule III. Diuretics should not if it can be avoided, be administered 
to a patient in bed. 

Rule IV. When the full effect of the medicine is required, give di- 
luent drinks freely. 

Utility of combining Medicinal forces in this class. 

In preceding remarks, I have frequently alluded to the combina- 
tions of medicines. There is perhaps no class in which a combination 
of two or more substances, possessing similar powers, is so frequently 
important as in diuretics. 

Thus the use of Potash joined with bitter vegetable infusions, is re- 
commended by Sir John Pringle as an efficacious medicine, and I have 
derived great advantages from uniting the Bi Tartrate of Potash with 
an infusion of Quassia. 

The alkaline substances by acting upon the bowels, are often preven- 
ted from reaching the kidneys, so their diuretic effect may often more 
certainly be secured, by giving an opiate at the same time, according to 
the practice of Dr. Mead. 

A combination of squill, with digitalis, and some of the less purga- 
tive preparations of mercury, as the blue pill, is occasionally very active 
in its diuretic operation, and in children, or in old and feeble people, the 
union of the sweet spirits of nitre with infusionsof the vegetable tonics, 
appears to be often very serviceable. 

PARTICULAR DIURETICS. 

[6] And such as operate by stimulating the secretories of the 

Kidney. 
Preparations of Potash — Sub-carbonate of Potash — Preparation — 
Best adapted to cases connected with acidity of the first passages — Com- 

7 



50 

bined with an infusion of Vegetable Tonics, its effects are best promo- 
ted. * 

Dose, 3i to 3ss 
Acetate of Potash — An article formerly much esteemed, but not much 
employed at the present time. 

Bi Tartrate of Potash^ or Cream of Tartar — Preparation — Very use- 
ful article, and employed in all the forms of Dropsy, but chiefly in as- 
cites and anasarca — Experiments of Home, Ferriar, and Manghini. To 
obtain success its use must be persisted in for some time — either given 
alone or in an infusion of Quassia or other Tonics. It sometimes hap- 
pens that it disorders the stomach and bowels, when its use must be in- 
termitted. 

f ss to f i largely diluted with water. 
Dose, a small cup full. 
, Adulterations. This article is frequently adulterated, sometimes with 
white silicious pebbles, bruised into small fragments, sometimes with 
Tartrate, and Sulphate of Lime. 

Nitrate of Potash — Properties — Employed in Tonic Dropsies. Given 
largely diluted. 

3i to 3iii dissolved in water, or cider, and this taken in 
small doses in twenty-four hours. 
The above salts, those combined with vegetable acids, it is proper to 
observe, do not enter the circulation in the form of Acetate or Bi Tar- 
trate of Potash. The digestive organs have the power of decomposing 
the salts, into which the vegetable acids enter as ingredients, and of elimi- 
nating their alkaline bases, so that the alkaline substance enters the sys- 
tem, probably combined with carbonic acid. The compounds with the 
mineral acids are not affected in the same manner, so that they enter 
the circulation in their combined state. 

Spiritus Mtheris Nitrosi — Dulcified Spirits of Nitre — Preparation — 
Properties — Adapted to Children — Usually combined with other articles. 
Dose, infant, viii to x m. 
Adult, 3i to fss. 

Diuretics, which to a local, exert a stimulant operation on the 

system generally* 

Tinctura Cantharidum, or Tincture of Cantharides — Natural History 
of Cantharides — Manner of collecting and preserving them — Analy- 
sis — Effects upon the organic structures of the body and particularly 
the urinary — Employed in the Atonic forms of Dropsy — In Dropsies 
succeeding Scarlatina ; in local diseases of the Urinary and Genital or- 
gans; in incontinence of Urine ; in Gleets and long protracted Gonorr- 
heas ; in Leucorrhea ; Impotence. 

Dose, xv to xx m, to z'i and 3ii — increased to the extent of 
producing irritation of the urinary organs. 
Urea — Preparation ; Diuretic operation considerable. 

Dose, xv grs. to 3i. 
Family Conifera; Pinus Palustris; Oleum Terebinthinse ; Prepara- 



51 



tion ; Effects upon the system ; Applied to the same disease as the Tinct. 
of Cantharides. . 

Dose, xv to xx m, increasing. 

Family Leguminosa — Copaifera Officinalis — Balsam Copaiva — Natu- 
ral History — Analysis — Term balsam incorrect, being a compound of 
volatile oil and resin — Irritating operation upon the stomach and intesti- 
nal canal. 

Effects upon the urinary organs — Diseases in which employed — In 
Dropsies — but in these cases not entitled to particular consideration. 
Employed in Chronic Catarrhs — Humid Coughs, and the Chronic affec- 
tions of the pulmonary organs — In diseases of the Genital organs — Go- 
norrhoea, Gleet, Leucorrhcea. In curing Gonorrhoea, this substance acts 
in two modes. By the irritation it excites upon the surface of the in- 
testinal canal, and the copious evacuations following, it reduces the gene- 
ral excitement of the system, and acts also by a revulsive operation. 

On the particles being absorbed, and the urinary secretion being im- 
pregnated, it changes the morbid action of the diseased part, and substi- 
tutes a medicinal impression, which is readily cured, for that of the dis- 
ease of the membrane of the urethra. Upon this principle other dis- 
eases are frequently subdued — Examples. 

Upon a like principle this article has been employed in protracted di- 
arrhoeas and dysenteries. Given in these cases in doses of twenty drops, 
combined with eight of Laudanum every four hours, in a table-spoonful 
of mucilage, or cinnamon water. 

Forms of Exhibition — In Drops, taken on sugar, or any aromatic 
tincture, or what is far preferable, in a table-spoonful of sweet-orange 
juice. — In Emulsion — Combined with the Tincture of Cubebs — In pills 
rubbed up with Calcined Magnesia — In Enemata. 

Formula — Preparations — Volatile Oil — Resin — Consolidated Balsam. 
Adulterations. This oleo-resin is easily adulterated with the thinner 
oils, or with turpentine. The detection of the fraud is often difficult, on 
account of the potency of the smell and taste of copaiva, which covers 
almost every other. M. Bucholz asserts, that if it does not dissolve in 
a mixture of four parts of alcohol and one of ether — that it is adulte- 
rated. 

Dose, xx m to 31. 

Family Polygalece — Polygala Seneka — Natural History — Properties 
much diversified — These enumerated — As a diuretic has been much ex- 
tolled by several physicians, as Milman, Hartshorn, Percival. It is not 
very efficacious employed alone, but requires the co-operation of other 
articles, as the Nitrate of Potash — super. Tartrate of Potash — The 
states of the system to which it is best adapted. 

Besides Dropsy, the Seneka has been recommended in high terms in 
Croup, and as an Expectorant in Pneumonia and Pleurisy. 

The period in-these diseases, in which it should be employed, is after 
the Inflammatory symptoms have abated, and the patient is harrassed 
with a dry cough, difficult expectoration, with slight feverishness, and a 
constricted skin. Under these circumstances, a decoction of the root 
will be found to afford great relief. 



52 

Decoction, prepared by boiling fss of the root in a pint and half of 
water to one pint. 

Dose, fss to f i every hour, according to circumstances. 
The addition of liquorice root to the decoction im- 
proves its taste. 
Powder x grs. to 3i with liquorice powder. 

[c] Diuretics which operate by increasing the action of the ab- 
sorbents. 

The several modes in which this may be effected, pointed out. 
Family Liliacece— Scilla Maritima, or Squills — Used in all the forms of 
Dropsy, though probably it is best adapted to Hydrothorax. In the early 
stage of Hydrothorax,medical treatment does a great deal, principally by 
means of diuretics, and squill is by far the most powerful of any. It 
never operates so powerfully, as when given to the fullest extent the 
patient can bear, without sickness. Beginning with a small dose, as 
thirty drops of the syrup, or tincture, three or four times a day, it may 
gradually be increased to fss or fi and more in the twenty-four hours. 
Carried to the extent mentioned, it will be found to operate very favoura- 
bly, and that in a {Jew days. The urine becomes pale and copious un- 
der its use, and proportional relief is obtained in the breathing, and in 
the diffused swelling.' Whether it will cure, depends upon the cause 
giving origin to the disease. 

In Hydrothorax when complicated, squill is combined with calomel in 
doses of ij grs. of squill and 1 gr. of calomel, made into a pill, and taken 
twice or three times a day. One of the best formula in the treatment 
of this dangerous and distressing form of the disease. 

Squill is sometimes combined with the Nitrate of Potash, in dropsical 
swellings and in nephritis— and instances of cures are related, by giving 
patients from ij to iv grs. of the former, with grs. x to xx of the latter. 

Squill has been much celebrated in the diseases of the Respiratory 
system. It is well adapted to promote expectoration, and to relieve the 
Bronchi when oppressed with a collection of mucus. It is properly 
resorted to in the conclusion of Catarrhal and other Pulmonary affec- 
tions, when Inflammatory action has subsided. 

In asthmatic affections, or dyspnaea, occasioned by the accumulation 
of viscid mucus, it has also been held in the highest estimation. As an 
expectorant, the squill may be supposed, not only to attenuate the mu- 
cus, and thus facilitate its ejection ; but by stimulating the excretory 
glands and mucous follicles, to excite a more copious discharge of it 
from the lungs, and thereby to lessen the congestion, upon which the dif- 
ficulty of respiration very generally depends. 

In the diseases of children, this article is also valuable. Its powers 
are much improved by combination with other articles, as the Polygala 
Seneka and Tart. Aniimony, as in the compound called Hive Syrup; 
and in asthma and dyspnsea without fever, combined with the Lac Am- 
moniac, it is perhaps the best remedy we can employ. 

Preparations — Acetum Scillae — Oxymel Scillse — Tinctura Scillse. 



53 

Dose, powder, ii to viii grs; 
Tincture 3ss to 3U' 
Vinegar, same. 

In Infusion — Vide Formulae. 

The infusion of squills is a convenient, and very useful form of ad. 
ministration, and in my practice one of the most successful, in removing 
dropsical effusions. 

Family Scrophularice. — Digitalis Purpurea — Foxglove — Natural His- 
tory. The leaves are gathered at the time the plant is flowering, the 
largest and deepest coloured being preferred. They are to be carefully 
dried in a warm room, through which a current of air is passing, and 
when completely dried, may be compressed into moulds, or kept in bot- 
tles closely corked, excluded from light and moisture. Effects of Digi- 
talis upon the system. — When given in a full dose, it exhausts the powers 
of the body, lowers the pulse from 75 to 40, and even 30 pulsations in 
the minute, produces sickness, vertigo — dimness of sight : and if the 
dose be very large, vomiting is excited, and a greater degree of vertigo. 
A dose still larger puts an end to life. Digitalis in its operation on the 
system, exhibits very striking properties. One of them is, a most sur- 
prising diminution in the strength, and especially the frequency of the 
pulse. Another remarkable effect is, that it may be given for a conside- 
rable length of time, without producing any sensible action upon the 
system, when its powers become suddenly developed ; to such a degree 
as to occasion alarm for the life of the patient, and though it is discon- 
tinued, its effects will remain for several days, being in this similar to 
mercury. Another peculiarity in the operation of Digitalis is, that it is 
influenced in its effects by the position of the body. In the first case 
which attracted notice, the pulse which was reduced to forty strokes in a 
minute in the horizontal posture, was in the sitting position quickened to 
seventy, and to 100 by standing. Medical History. Employed in 
Dropsical Affections — Conditions of the system most favorable to its 
use — Forms of Dropsy to which it is best adapted. Though its powers 
have been much overrated, there is also much inattention shewn to the 
states of the system in which its effects are best exhibited, and to the ar- 
ticle being in a proper state, and properly administered. Given in the 
form of infusion — Preparation. Dose 3i to fss. Directions to be ob- 
served in its use. — When carried to the extent of affecting the system 
either by the pulse, the stomach, bowels, or head, I have on several occa- 
sions observed its diuretic operation exerted to a considerable degree, and 
like other practitioners, began to be sanguine in my expectations of 
cure. I have, however, been disappointed, and am convinced, that the 
effusion we call dropsy, is often, only a symptom of greater derange- 
ment, or of alterations in organic structures, which while they continue, 
though the effusion may be removed, yet it soon returns, and by ex- 
hausting the powers of life, by draining the vascular system, by injuring 
the texture of parts into which it is poured, by the confinement of the 
patient, and the anxiety he suffers, the case terminates fatally. Still we 
are not to abandon a patient under these circumstances, but approach 
the treatment, with the use of means, which may directly or indirectly 



54 

be made to bear on' the case,; and digitalis employed as directed, may 
prove useful. Utility in other diseases. In Hoemoptysis of advantage 
in controling the circulation after depleting measures have been proper, 
ly pursued — Employed in Haemorrhages from other organs — In Phthisis 
Pulmonalis of little value — No power to contend with Tubercular for- 
mations. 

Having placed before you the opinions of men distinguished in our 
profession, as to the utility of Digitalis in Pulmonary Consumption, can- 
dor obliges me to confess, that present experience with this article, by 
no means entitles it to these encomiums. In proof of it, I remark, that 
Consumption is a fatal disease, much so in our country, and still more so 
in Great Britain, where one-fourth of all the deaths are occasioned by 
its ravages. There are many Pulmonary diseases, bearing a close re- 
semblance to Phthisis, in which this article has been employed, and suc- 
cess following its use, has caused it to be considered a remedy in this com- 
plaint. The wasting of the flesh which occurs in Phthisis, is common 
to other .diseases, with the fever, pain, cough, thick expectoration,* diffi- 
culty of breathing, &c. These symptoms are often observed in Ca- 
tarrhs, as a consequence of Pleurisy, and other cases, in which the pa. 
tient often recovers. In consumption, the action of disease is peculiar, 
and is different from the morbid action occurring in other parts of the 
body. It generally arises from Tubercles, which are of a nature analo- 
gous to scrofula, being very slow and tedious in their progress. This 
progress is sometimes completed, and the tubercle heals. But it is often 
succeeded by a multitude of others, which in succession inflame, and 
suppurate. It is this constant disease, to which there is no end, that 
wastes the system, and renders the case incurable. 

The singular property of Digitalis to lower the pulse, without increas- 
ing evacuations to any degree, renders it particularly valuable in these 
cases. Hitherto this object has only been obtained, by withdrawing from 
the circulating fluids, or by producing nausea. Digitalis is so far an in- 
valuable remedy, as it enables the physician, in most cases, to accomplish 
this object. With a reduction of the frequency of the pulse, relief is 
afforded to many distressing symptoms of the disease, as pain in the 
side, cough, dyspnoea, fever, and if this remedy is resorted to early, and 
proper attention paid to diet, and exercise, much benefit will doubtless be 
derived from its use. Even when the disease is more advanced, and 
from the feeble and irritable state of the patient, bleeding can no longer 
be employed, Digitalis in such doses, as keeps the pulse at a more natu- 
ral standard, may be highly beneficial. But in the more advanced sta- 
ges, when purulent; expectoration, and its train of distressing symptoms 
exist, nothing can do more than palliate, and smooth, the avenues of 
death. 

Digitalis has been employed in Epilepsy — in some of the Phlegmasia?. 

Morbid effects produced by this article — Symptoms of their approach. 
These are retardation of the pulse, palpitations, faintness, sickness, and 
purging. There is, likewise, a pain in the head, sometimes over one eye, 
with disturbance of the functions of the t brain. When any of these 
symptoms occur, the medicine must be discontinued. 



55 . 

The remedies to be employed, will consist of .an, Emetic, if the degree 
of prostration does not forbid it. iEther, Volatile- alkali, brandy and 
cordials — Sinapisms and blisters, are also important. ' • . 

Dose, powder, g. i 

Tincture, xx m. increased. 

Family Solanece — Nicotiana Tabacum— Employed as a Diuretic. 
To Dr. Fowler we owe much that is known upon the diuretic ac- 
tion of this article. His work upon this subject was published in 
1785. In it he speaks with the usual extravagance, which characterises 
those, who are patrons of particular articles, and says that out of one 
hundred and fifteen cases, in which he administered Tobacco, in ninety, 
three of them it proved diuretic. He further states, that in thirty-one 
dropsical cases, in which he employed it, thirteen were' cured, and ten re- 
lieved. Subsequent writers have also spoken of it. I have employed 
it on several occasions, and am satisfied that it may be resorted to with . 
considerable prospects of success, as a diuretic — and where there is no 
organic disorder, as a remedy in dropsy. It is given in the form of Infu- 
sion and Tincture. 

In Chronic Catarrhs, Phthisis Pulmonalis, and other chronic diseases 
of the Lungs, it is an article more to be relied upon than Digitalis. 

The objections to this article, arising from its tendency to produce 
nausea, may be obviated by commencing with a small dose, and increas 
ing a drop with every portion, until some sickness" at the stomach is ex- 
perienced. 

Infusion is prepared as in the Formulae. 
Dose, x to xx and lx m. 

Tincture or Wine — : the same. 

Family Colchicece — Colchicum Autumnale — Meadow Safron. Natu- 
ral History — Sensible Properties. Writers differ much in their opinions 
respecting the effects, and sensible qualities of the root. By some it is 
stated to be void of taste and acrimony, and that considerable quantities 
may be taken without inconvenience, except that of an ungrateful bitter- 
ish taste. Baron Stork, on the contrary, tells us, that by gently rubbing 
the root against the tip of the tongue, it renders the part rigid, and almost 
void of sensation, for several hours. These contradictory statements 
can only be reconciled, by supposing the roots to vary much according 
to age, the soil in which they grow, and probably still more, the season 
of the year in which they are dug up. The root, therefore, should be 
taken up by the middle of summer, for medicinal purposes, since they 
become nearly inert while producing their flowers. Analysis — Intro- 
duced into practice by Baron Stork, and employed in Dropsies in the 
form of Syrup. This preparation superceded, and in place of it the Col- 
chicum Wine substituted. Effects upon the system. Employed in 
Dropsy, in Gout and Rheumatism. In the last disease, a tincture of the 
Seeds preferred. Employed in the treatment of Inflammatory diseases, 
acute as well as chronic. Externally the Tincture is employed as a 
Liniment in Rheumatism — one or two tea-spoonsful to be rubbed at a 
time, upon the part. The Tincture of the Seeds may be used in the 
same manner. 



56 

Preparations. 

• Dose of the Oxymel, 31 increased. 
Of the Wine, xxx to xl m. 
Of the Tincture of the seeds, xx to xxx 
Veratria — an alkaline principle obtained from the seeds of the Vera- 
trum Sabadilla. 

This article has of late been employed in the treatment of Neuralgia, 
particularly in Tic Doloroux. The external use of the Veratria has 
succeeded in removing the disease, after other means had been unavail- 
ingly employed. 

Also employed in partial- Palsy, affecting different parts. The man- 
ner of using it, is in the form of-ointment, prepared by rubbing a scruple 
of the Salt with an ounce of Lard. 

Diuretics varied in their action. 

Family Iridees — Iris Versicolor, or Blue Flag. Indigenous. Natu- 
ral History — Effects upon the system — Employed in Dropsies, combined 
with the Button Snake Root, and thus united, has been used with great 
advantage in obstinate cases. Given in Decoction. 

Formula. 

Dose, 1 pint daily. 

Family Umbelliferce, — Eryngium Aquaticum vel Yuccifolium — Button 
Snake Root. Indigenous — Natural History — Properties. United with 
the preceding article in the treatment of Dropsies. In the form of 
Tincture, employed in Indigestion, &c. 

Dose, Tincture, 3i increased. 

ApiumPetroselinum — Parsley. Indigenous — Natural History. Use- 
ful in Strangury — In suppression of Urine occurring in children — Em- 
ployed in the form of Decoction of the root — alone, or combined with 
the Nitrate of Potash. 

Family Ericinece — Chimaphila Umbellata — Pipsissewa. Indigenous — 
Natural History. Properties. Employed in Dropsical Affections, par- 
ticularly in those cases accompanied with enfeebled digestion, and lan- 
guid condition of the vital powers. 

1 pint of a strong infusion, daily. 

Externally employed as a wash for foul ulcers. 

Family Aloideos — Aletris Farinosa — Star Grass— Indigenous. Natu- 
ral History. Employed in similar cases. 

Decoction of the root and leaves in liberal doses. 

Other articles — Erigeron Heterophyllum. Sweet Scabious. Achy- 
ranthes Repens, Forty Knot, &c. 

General principles determining the extent of operation of this class 
of Medicines; 

Division VIII. 

LITHONTRIPTICS AND ANTILITHICS. 

The nature of the urinary secretion hae been the subject of much in- 
vestigation, both on account of its supposed connection with many dis- 



57 

eases, and on account of the very singular products derived from it. 
From an analysis, which has been. made by several chemists, it is found 
to consist of various acids, and salts, in its healthy state, and from the 
predominance of a few, or their varied combination, the varieties of hu- 
man calculi are derived. 

The several principles contained in Urine enumerated. 

Such being the nature and composition of urine, it may be supposed 
that when the quantity of these substances is augmented beyond what 
can be held in solution, urinary concretions or calculi would be found. 

Particular states of the constitution, give rise to the formation of these 
ingredients, and when carried to excess, is called the Lithic Diathesis- 
This state of the system, is probably, intimately connected with the de- 
ranged condition of the alimentary canal, and the first link, in the chain 
of causes, giving rise to the production of these substances, has its ori- 
gin in the stomach. 

The different substances which enter into the composition of urinary 
calculi, enumerated — and arranged under the following heads : 

1. Lithic or Uric Acid. 

2. Phosphate of Lime. 

3. Ammoniaco Magnesian Phophate. 

4. Oxalate of Lime. 

5. Cystic Oxyd. 

Such being the state and condition of the digestive organs, previous 
to the appearance of stone or gravel, it will be obvious, that the remedies 
called Antilithics, are such as will strengthen these organs, and correct 
the morbid condition of the first passages. How it happens that such 
a variety of deposites are formed, is difficult to conceive, and the only 
explanation I can attempt, will be to suggest the various, and almost in- 
terminable results of morbid action, as exhibited in a diseased state of 
the liver, or other organs of the body. 

The other class of Medicines, or Lithontriptics, are employed during 
the formation of urinary calculi, or after they are formed. To produce 
a solvent effect, it is necessary that they be brought into contact with 
the substance itself, and this is effected by the remedies passing into the 
circulation, from whence being separated by the kidneys, they are thrown 
into the urinary organs, where they exert a solvent action, upon the de- 
positions which may exist. 

The practicability of this operation taking place, to a certain extent, 
inferred from several circumstances mentioned. 

The conclusions drawn upon this subject, are 

1. That these medicines are not entitled to be considered solvents of 
stone in the bladder. 

2. That in small calculi or gravel, or the forming stage of the disease, 
the symptoms derived from this cause, with the concretions, have been 
relieved, and dispersed, by the proper and judicious use of alkaline and 
acid medicines. 

3. That in advanced stages of the disease, or after stones exist in the 
bladder, the symptoms of irritation they produce, have been so much re- 
lieved by acid, or alkaline medicines, that the patient's life has been ren- 

8 



58 

dered easy, and comfortable, to such a degree, by changes induced upon 
the surface of the stone,, as to excite a belief that it had been dissol- 
ved, though it was discovered in the bladder after death. 

4. That even supposing these medicines incapable of exerting any ac- 
tion upon the urinary organs, yet by correcting the morbid condition of 
the alimentary canal, either from a state of acidity, or alkalescence, 
that they thereby disturb those affinities, which in the subsequent pro- 
cesses of assimilation, and secretion, give rise to calculous formations. 

The last and most important principle in this discussion, remains to 
be considered, viz. how are we to discover the nature of the calculous 
secretion, so as to direct a suitable remedy? A knowledge of this prin- 
ciple, is of primary importance, for without some rules to guide us, our 
practice is but empiricism, whence it is, that failing in several attempts 
to afford relief, we hastily decide, that all is conjecture and uncertainty; 
that the practice, in this instance, is based upon an unstable foundation, 
when, in fact, the fault is not in the remedy, but in our insufficient know- 
ledge of its application. 

In the inquiry, as the means by which we are to be directed, in the 
choice of a remedy, adapted to the chemical character of the calculus, 
we are to be governed by an examination of the sediment, deposited by 
the recent urine, or an analysis of the small fragments, which are fre- 
quently voided with it. It is in this stage, as I have observed, that we 
prevent such accumulations from taking place, which may end in stone. 
Of the many substances which are contained in urine, rarely more than 
three, make their appearance in the form of deposite, or gravel. These 
are the phosphate of lime, phosphate of ammonia and magnesia, and uric 
acid. The former constitute a white, and the latter, a red deposit. Re- 
marks upon each, and their appropriate remedies. 

ANTILITHICS. 

Of this character are the Medicines which improve the tone of the ali- 
mentary canal — Several articles from the class of Tonics enumerated. 

Family Ericince — Arbutus Uva Ursi — Bear Berry. Natural Histo- 
ry — Much difference of opinion respecting its virtues — Useful in allay- 
ing pain in calculous diseases — Employing with advantage in Nephritic 
affections. In diseases of the bladder — In Catarrhus Vesicas — In sup- 
purations of long continuance, in protracted gonorrhoeas, &c. 
Dose, powder, x grs. to 3ss. 
Infusion, 3iij to f ss to water 1 pint 

Family Urticea — Humulus Lupulus, or Hop — Indigenous — Natural 
History — Lupulin — Is pbssessed of tonic and narcotic properties — Medi- 
cinal virtues extolled beyond its merits — In Nephritis employed with ad- 
vantage, given in the form of infusion. 

Infusion f ss to water 1 pint. 

Family Umbelliferce — Daucus Carota, or Wild Carrot — Indigenous. 
Natural History — Is possessed of considerable acrimony and bitterness. 
An infusion of the roots and seeds is employed in some of the diseases 
of the urinary organs, and occasionally with benefit. 



59 

Family Liliaceoz — Allium Sativum or Garlic — of little value. 
Importance of Diet as an Antilithic. Experiments of Dr. Wollaston. 

LITHONTRIPTICS. 

1. Solvents of the Alkaline deposits. 

Carbonic Acid — Useful to the patient, and grateful to the system. 
Prepared by the dealers in Mineral Waters — or impregnating water by a 
Nooth's apparatus. 

Mineral Acids — General and Relative Importance — The Muriatic pre- 
ferred. 

Dose, v to xx m. " 

Vegetable Acids — Under certain circumstances preferred to the Mine- 
ral. 

Tartaric Acid, in doses of from v to xx grains, may be employed. 

2. Solvents of the acid deposits. 

Carbonates of Potash and of Soda — Latter preferred — cases of their 
utility cited — Administered in solution with the mucilage of gum arabic 
or in weak broth, or saturated with carbonic acid gas. 
Dose, 3i to 3ss repeated. 

Soap — Has no advantage separate from the alkali it contains, and as 
in this state, it is apt to impair the digestive powers of the stomach, and 
lay the foundation of dyspepsia, is seldom employed. 
3ss to f ss daily in pills. 

Lime Water — was much commended by Dr. Whytt, and benefit was 
supposed to have been derived from its use in Lord Walpole's case — 
but it is an inconvenient and ineffective form of alkaline medicine, and 
not entitled to much consideration. 

1 quart to 3 pints daily. 

Magnesia — Has peculiar advantages in the cases under considera- 
tion — corrects the conditions of the first passages which favors the for- 
mation of uric acid — Particularly useful when the alkalies have been em- 
ployed a long time without much benefit, or when they excite flatulence, 
or indigestion. 

Dose, xv to xx grs. several times a day. 

Injections into the bladder have been proposed, consisting of acid or 
alkaline solutions — The Gastric juice of animals, particularly the hog, 
proposed by the late Dr. Dorsey. 

Division VIII. 
Medicines which promote the Catamenial Secretion- 

EMMENAGOGUES. 

General Remarks upon the Catamenia — Its nature and importance. 
Its suppression connected with several forms of chronic disease. Medi- 
cal men being aware of this fact, have applied themselves with diligence 
to promote this secretion — but from the frequent failure of their endea- 
vours, doubts have arisen, as to the beneficial effects of medicines in 
these cases. The precariousness of this class of medicines, those who 



60 

have had experience must allow — still -I am decidedly of impression, that 
we are possessed of medicines, which exert an action upon the secretions 
of the uterus, .and if failure attends their administration, it proceeds 
from the incorrect ideas which are entertained of the nature of the Cata- 
menia, and our inattention to the state of the system. The fact is, the 
practice in these cases often is in a great degree empirical, and the 
want of success proceeds from neglect of those circumstances, which 
should influence their operation. Alibert observes, that there are few 
diseases, which depend upon such a variety of causes, or are connected 
with such different conditions of the general system, as obstructed ca- 
tamenia. Hence, its remedies are so various, and often of such contra- 
ry characters, and hence too, the great uncertainty of our remedial 
measures in such cases. Many of us may have observed, the great fa- 
cility with which the emmenagogue operation, of a particular agent, 
has been produced, after the system has been subjected to a process of 
preparation, when the same substance has proved perfectly futile with- 
out it. 

In some cases, the suppression of the secretion is produced, by the 
general relaxation and debility of the system, and hence, our best reme- 
dies will be such, as will invigorate and restore it. Here exercise, to- 
nics, the cold bath, and a nourishing diet, produce the best effects. 

At other times, an opposite condition of the system exists, connected 
with a considerable degree of rigidity of fibre, and a high degree of Ar- 
terial action. In these cases a contrary plan is to be pursued, and the 
best emmenagogues will be venae section, and other depleting remedies. 
In prescribing, therefore, for a suppression of the catamenia, it is of 
the utmost importance to attend to general state of the system, as with- 
out it, we shall frequently be baffled in our attempts, and our medicines 
may often increase the disease they were designed to cure. 

I shall divide the medicines of this class, into such as increase, and 
such as diminish, arterial action : and before commencing to speak of 
the individual articles, I cannot but state, that I think we are possessed 
of remedies, adapted to the varying condition of the system, provided 
we use judgment in their selection. 

[«] Such as increase arterial action. 

Under this division is comprehended those articles which stimulate 
the arterial system, and those which give tone to the system generally. 

Family Polygalece, — Polygala Seneka — Properties — Cases of its utility 
cited — Best adapted to habits that are weak and feeble — and of a tem- 
perament apparently cold and leucophlegmatic. It is proper in using 
this article, always to commence a week, or ten days, before the period, 
when the catamenial secretion is expected. It produces no mischievous 
effects, and might be exhibited very safely for a much greater length of 
time. 

Exhibited in the form of Decoction, by simmering slowly fss to f i of 
the bruised root in a pint of water, until it is reduced one-third. Dose 
fss to f i, several times a day — and to a greater extent when necessary. 



Should it produce nausea, which it is apt to do, it may be prepared with 
the addition of an aromatic, as cinnamon, &c. 

Family Coniferce, — Juniperus Sabina or Savin — Natural History- 
Properties — Experiments of Home and others* -with this article as an 
emmenagogue. 

The constitutions to which it is best adapted, are the weak and re- 
laxed — Employed also in Chronic Rheumatism* 

Externally employed in powder as an escharotic — In infusion as a 
wash for ulcers — In taenia capitis, and in the form of ointment, to keep 
up the discharge from blistered surfaces. h 

Dose, powder, 3i to 3ii 

Decoction fi of the leaves to water 1 pint, boiled to half 
a pint, to which add syrup f ii— rdose, a wine glassful 
every 2 or 3 hours. 

Besides these modes of administering the savin, the essential oil has 
been highly recommended, given in the quantity of vj drops on a lump of 
sugar increased to x or xii. 

Juniperus Virginia — Natural History — Properties and uses as the 
preceding. 

Tinctura Cantharidum — Tincture of Cantharides — Effects upon the 
abdominal and more especially the pelvic viscera — Its utility connected 
with its operation on the latter— particularly when given to the extent 
of producing strangury. In the production of strangury, its action 
would not appear to be confined to the bladder, but it excites all the dif- 
ferent organs in its neighbourhood. The uterus partakes of this action, 
and thereby often excited to pour out the menstrual secretion, and in 
my opinion, the emmenagogue power of this article, depends chiefly on 
these local effects, rather than upon its stimulant operation on the gene- 
ral system. The bowels, we know, are much affected by the production 
of strangury, and patients have been heard to complain, that the pas- 
sage of the faeces through the rectum, excited a sensation of heat, or 
burning, similar to that which attends the voiding of urine. If such be 
the strength of the impression produced by the presence of strangury 
upon the alimentary canal, the uterus, we may suppose, is likely to par- 
take of an equal inflammatory action. Cases of its efficacy cited — Con- 
nection of several chronic forms of disease, with the suppression of the 
Catamenia exhibited, viz. Mania, Nymphomania, Epilepsy, Phthisis. • 
Dose, xv to xx m. increased. 

I have alluded to the connection between chronic derangements, and 
the suppression of the catamenia. The several cases I have related, 
have been illustrative of the dependance of mania, nymphomania, epilep- 
sy, and phthisis, on that cause. The connection of the first diseases with 
the state of the menstrual secretion is admitted ; but with phthisis, the 
relation has been overlooked, or not acknowledged. The present occa- 
sion is too favourable a one, not to state to you, that, in my opinion, 
amenorrhoea is often the cause of consumption. The case cited, con- 
firms this opinion : and, at all events, it is an interesting subject of en- 
quiry, whether the pulmonary disease is not occasioned by the suppres- 
sion, and whether, in certain cases, amenorrhoea does not prove a cause 



. .. . \ t ; 62 

of phthisis in the pre-disposed ? My own views are favourable to this 
connection, and in the treatment of cases of phthisis as well as some 
other complaints, would suggest directing the attention to the suppres- 
sion, as forming the chief diseases, upon the removal of which all the 
other symptoms will vanish, provided the secretion Can be restored be- 
fore the lungs have sustained such organic injuries, as to render them 
incapable of continuing duly to perform their proper functions. Certain 
it is, that no occurrence is more common, than the attack of cough, 
pain in the side, difficulty of breathing in females, soon after the obstruc- 
tion of the menses, and upon its recurrence all these symptoms going off. 

The connection derives much support from the knowledge, that the 
approach of phthisis is generally much more insidious, and its progress 
more slow in women than in men, and that this difference depends upon 
its being rather symptomatic, than idiopathic, in females. In other cases, 
where it arises from' some obvious occasional cause other than the cata- 
menia, and to which females are subjected as well as males, its progress 
is equally rapid and violent. Impressed with this belief, I would recom- 
mend, that we keep in view the probable dependence of the pulmonary 
symptoms, and the other diseases mentioned upon the interrupted func- 
tions of the uterus, and direct our treatment accordingly. 

But you will inquire, how are we to distinguish those cases in which 
Phthisis is of symptomatic origin, from others ? Its symptomatic origin 
may be ascertained, by the suppression preceding the appearance of the 
pulmonary affection — and when such is the case, the disease if not de- 
pendent, has, at least, an intimate connection with the state of the uterine 
secretion. Under these circumstances, advantages, I can assure you, 
will result from re-establishing the discharge. 

When phthisis has existed for some time, this secretion, with others, 
will be deficient, or suppressed, from the enfeebled condition of the gene- 
ral system. So impressed is the female mind, with the general ill-effects 
of this state of things, that even here, you will often be urged to do 
something, and advisers will not be wanting, who will press upon you the 
necessity of so doing. Here, however, it can be of no advantage, and 
you will be obligedio resist and combat with much opposition. Do it in 
this and all other instances, with kindness and forbearance, explain your 
views clearly, and divested of technicalities, and, from some experience, 
I am satisfied, that you will make your opponents your friends. 

Family Rubiacece — Rubia Tinctorum — Madder — Natural History — 
Properties. Opinions of Home, B. S. Barton, Dewees, and others. 

Respectable, however, as is these authorities, and this weight of evi- 
dence in its favour, it is employed by few physicians at the present day, 
and whatever may be its virtues, it does not possess the confidence of 
the profession at large, as an article adapted to restore the uterine secre- 
tions. Indeed, in my opinion, an article exhibiting so few active pro- 
perties, and which, from the mildness of its impression, can be employed 
under almost any circumstances, and without reference to the states of 
the system, can be little entitled to consideration in a practical point of 
view. It is not with such instruments that disease is to be arrested, or 
deficient secretions excited. In proportion to the mischief an article is 



63 

capable of doing when improperly administered, would I estimate the 
benefits to be derived from it, in the hands of a cautious and judicious 
practitioner. You have heard the authorities in favour of this article, 
and may form your own opinions. 
Dose, |ss to 3i 

Secale Cornutum — Spurred Rye — Ergot — Natural History. The on- 
ly opinion which appears to be well supported is, that the Clavus is a 
Parasitic Fungus, a species of Ustilago, like the different sorts ot blight, 
smut, &c. Of this opinion is Decandolle. It affects most of the Cere- 
alia, but rye seems, to be most apt to take on this morbid condition, par- 
ticularly when the plant grows in low damp situations, and when it is 
exposed to heat succeeding heavy rains. It is found in greater abun- 
dance on the margin of fields than in the central parts. 

The appearance and properties of the Clavus. 

Its most prominent effect is, its direct action upon the uterus, produ- 
cing and increasing contractions, when there is a predisposition to ac- 
tion in that organ, and restoring the catamenial secretion when obstruc. 
ted. It must, therefore, be ranked in the M. M. as a Paitus accelerator, 
and as an emmenagogue. 

Medical History. This article was known to Holland and France in 
the middle of the last century. From the indiscriminate manner in 
which it was employed, injurious results followed, and we find it prohibi- 
ted in France by a legislative decree. In 1807, its use was revived by 
Dr. Stearns of New-York, who was led to make trial of it, from the 
powerful effects it produced in the hands of some ignorant Scotch wo- 
men. My information, he says, was such, as to impress upon my mind 
the necessity of extreme caution in my first experiments. The contin- 
ued influence of this impression upon my subsequent practice, has been 
a source of much consoling reflection. 

There can be no doubt at present, that this medicine has the power of 
exerting a specific action upon the uterus — that this action consists in 
augmenting the contractile power of that organ during parturition, and 
in lingering and protractedjjases, inducing forcible contractions, and ex- 
pediting delivery. The concurrent opinion of most physicians is deci- 
dedly in favour of these effects. 

These effects are not more extraordinary than the almost instantane- 
ous manner in which they are produced. In twenty cases, says Dr. 
Prescott, I carefully noticed the precise time it required to produce its 
customary operation. In two of them the increased strength of the 
pains, and the continued action commenced in seven minutes from the 
time the decoction was taken. In one case it was eight minutes, in 
seven it was ten, in three eleven, and in other three cases it was fifteen 
minutes. 

In the employment of an agent so powerful in its operation, certain 
rules and directions become necessary to prevent any bad consequences 
which might arise from its use, and which are more particularly proper, 
as the action when excited is so little under controul. 

The rules necessary in its administration, are 

Rule I. That it should never be administered when nature is compe. 
|ent to a safe delivery. 



64 

Rule if. It should never be given until the regular pains have ceased, 
or are ineffectual, and there is danger to be apprehended from delay. 

Rule III.. It should never be administered until the rigidity of the 
os uteri has been overcome, and a perfect relaxation induced. When 
labour has been protracted from the rigidity of the os uteri, or of the 
soft parts, these obstacles should be overcome by venae section — after 
which the ergot may be usefully employed, and its operation will be 
found mild and efficacious. 

Rule IV. It should never be administered in the incipient stages of 
labour, nor until the os uteri is dilated to the size of a dollar. 

This rule is of the utmost importance, the success of the article being 
very much influenced by the time when it is employed. When given 
in the early stages of labour, and before the os uteri is sufficiently dila- 
ted and relaxed, it often fails of success. The pains induced under these 
circumstances, often terminate before the labour is accomplished, and 
are of no advantage. 

Rule V. It should never be administered in any case of Preternatu- 
ral Presentation, that will require the foetus to be turned. The necessity 
of this caution will be obvious, when it is considered, that the violent and 
forcible contractions induced, will add much to the difficulty and hazard 
of the operation. 

With these precautions in the use of the Ergot, it may be safely and 
effectually used, and the relief afforded will, from the united testimony 
of those who have written on the subject, be gratifying in the highest 
degree. Without a regard to these rules, the most mischievous conse. 
quences will result, and an article capable of serving many valuable 
purposes, will be neglected and abandoned. 

Having premised the rules which are to be observed in the administra- 
tion of the Ergot, I shall proceed to consider those cases in whicn it is 
necessary to have recourse to it. 

1. The Ergot is indicated in those cases, where the expulsion of the 
child is delayed from the action of the uterus being weak and ineffec- 
tual, — where it has descended into the pelvis, and the soft parts are pre- 
pared for its passage. Any delay to its expulsion when in this situation, 
would be attended with danger to the mother from pressure on the soft 
parts, or from the exhaustion of strength, and vital energy, which might 
ensue from hemorrhage, or other alarming symptoms. In these cases, 
the action of the Ergot, by renewing the uterine contractions to a con- 
siderable degree, speedily effects delivery. 

2. When the pains are transferred from the uterus to other parts of 
the body, or to the whole muscular system, as in puerperal convulsions. 
In these cases, Dr. Stearns observes, that after copious blood-letting, the 
Ergot concentrates all these misplaced labour pains upon the uterus, 
which it soon restores to its appropriate action, and the convulsions cease. 
The beneficial effects of this practice is also confirmed by Dr. Water- 
house, who in a case of violent puerperal convulsions, accompanied with 
dilatation of the os uteri, succeeded by employing the ergot, in restoring 
the pains to the proper organ, in a manner almost instantaneously, he 
says, and truly astonishing. 

3. When in any of the stages of pregnancy, abortion becomes inevi- 



65 

table from haemorrhage — cases complicated with haemorrhage, call forth 
all the decision and energy of the Medical character.'- Their manage* 
ment is connected with much hazard 10 the motheY, and to the physi- 
cian, a scene of trial and difficulty. Under these circumstances to 
know, that we possess a remedy, the action of which tends to restrain 
the haemorrhage, must be attended with consolatory reflections. The 
indication to be fulfilled, is to excite the uterus to contract, and expel its 
burthen, as by this means only, the haemorrhage can be arrested. The 
ergot, from its action upon the uterine fibres, presents itself as a remedy 
suited to these purposes. It .must be given to the extent of exciting 
contractions, and when these are produced, the flooding will commonly 
cease. 

4. The ergot is indicated in cases of labour, complicated with uterine 
haemorrhage. The same remarks as in the preceding, are applicable 
here. The haemorrhage must be stopped by plugging the vagina, the 
use of cold applications, &c, until the os uteri is dilated, when the ergot 
may be tried with safety and effect. . • 

5. Where the placenta is retained from the want of action in the 
uterus — I have seen several instances of the beneficial application of 
this article in such cases, and from all that we know of its operation, the 
ergot will be well adapted to effect its expulsion. 

6. The ergot will be beneficial in cases where haemorrhage occurs 
after delivery. It occasionally happens, that the uterus, from the want 
of tone, does not contract after the delivery of the child and secundines, 
in consequence of which, flooding is very apt to ensue. This is what 
has been called relaxation of the uterus, and is a state of extreme dan- 
ger. It may be known by the abdomen being large and flaccid, and the 
uterine tumor not being perceptible above the pelvis. In these cases, 
the ergot will be found very efficacious, and in a short time excites con. 
tractions of the uterus. I cannot conclude this summary of the benefi- 
cial effects of the ergot, without stating to you the opinion of Dr. Dewees 
on this subject. It would appear, he says, from all I have been able to 
collect, and from all I have observed, that it rarely fails, or disappoints, 
when properly prosecuted. 

Objections to its employment answered. Manner of exhibiting the 
Ergot in Parturition. It does not exert as beneficial effects when admin- 
istered in powder, as in decoction. In this latter form it is prepared, by 
infusing 3ss of the bruised Ergot in f iv of hot water. Of this, one-third 
is taken as a dose. If the pains are not sufficiently severe in twenty mi- 
nutes, half the remainder is given, and the last dose if necessary ; but 
this is rarely the case. While this quantity produces its most favourable 
effects upon the uterus, it does not affect the stomach with nausea, or 
vomiting, which sometimes interrupts its successful operation. 

Besides the cases already mentioned, in which ergot may be success- 
fully resorted to, it has been employed in profuse discharges of the Loc- 
hia, in Menorrhagia, by several persons, and by myself, with very grati- 
fying results, and in haemorrhages from other organs. 

The Emmenagogue operation of this article considered, with cases of 

9 



66 

its efficacy. It may be givln in Powder, in doses of xv grs. to 3i three 
times a day, or in Infusion made stronger than directed. 

Morbid effects produced by the Ergot. 

Two distinct set of symptoms have been noticed. • The one a nervous 
disease, which is characterised by violent spasmodic convulsions, called 
by the French, Convulsive Ergotism. 

The other being a depraved state of the constitution, which ends in 
that remarkable disorder, dry Gangrene ; also called Gangrenous Ergot- 
ism — Creeping Sickness, &c, from its being preceded by general 
weariness, weakness, and a feeling of insects creeping over" the skin, 
followed by a numbness of the feet and toes, which, in a short time, be- 
come shrivelled, dry, drop off— and the two affections are not blended to- 
gether in the same individual. 



Guaiacin the form of vol. tincture has been recommended in very high 
terms in Amenorrhsea and Dysmenorrhea, by Dr. Dewees. His suc- 
cess with it, - has' been so considerable that he has pronounced it a spe- 
cific in these cases, and employs it almost to the exclusion of every thing 
else — Vide Formulae. 

The dose is a tea-spoonful three times a day in a wine-glassful of 
water or milk. The Volatile Spirits of Ammonia is added in the pro- 
portion of z'i to ^iv of the Tincture. Should it operate upon the bowels, 
a few drops of Laudanum may be added. 

Stimulating Injections. 

Under Stimulating Emmenagogues, may be mentioned the employ- 
ment of Aqua Ammonia, in the form of injection into the vagina. This 
practice was first proposed by an Italian, and he relates cases in which 
this treatment succeeded in a few days, to produce the discharge. The 
proportion used, was x or xii drops of Ammonia, in two table-spoonsful 
of warm milk, often repeated in the course of the day. It generally 
produced in the vagina a sensation more or less painful, according to 
the strength of the mixture, and the sensibility of the part, but in no case 
was any thing dangerous or troublesome produced. 

Electricity. 

It is natural to suppose, that a power of such energy as Electricity, 
would be applied to Medicinal purposes, especially since it has been found 
invariably to increase the insensible perspiration, to quicken the circula- 
tion of the blood, and to promote the glandular secretions. — Accordingly, 
many instances occur, in the later period of the history of this science, 
in which it has been tried on various occasions, with considerable ad- 
vantage and success. In most of the cases in which it has been used 
with perseverance, it has given, at least, temporary and partial relief— in 
many effected a cure. Of its utility in amenorrhsea, there is not want- 



67 " 

ing the weight of high authority, and the experience of many in this 
city, who have employed and recommended it. The authority of Cul- 
len and Cavallo cited. The latter observes, that its operation in promo- 
ting the glandular secretions, seems to be, by its mechanical stimulus, 
and it has this great advantage, that it may be directed to any particu- 
lar organ. 

The experience of the late Dr. Shecut, with this remedy, in its appli- 
cation to this disease. Of forty. nine cases which were submitted to 
electrical treatment, thirty-four of them were effectually cured, and the 
remaining fifteen relieved from their most distressing symptoms. More 
might have been cured, for he adds, that it is too common with patients 
when they find themselves relieved, to trust to natu.re for the rest.- 

In bringing before you this statement, I should observe, that such is 
the dread entertained by females of electrical sparks, together with the 
trouble of being carried to a machine, that.it is seldom resorted to until 
medical treatment has been practised to some extent, so that I may say 
the usual remedies had been unsuccessfully employed. „In confirmation 
of the utility of electricity, I am acquainted with a lady of this city, who 
for six years, laboured under a suppression of the menstrual secretion, 
in whom, to the ordinary distressing symptoms, was added such strong 
convulsive paroxysms, as to render the approach of her monthly peri- 
ods, the occasion of great dread, and painful forebodings to her friends. 
From her situation in life, the first physicians were employed, and every 
expedient which medical skill suggested, was united with the utmost 
care and assiduity in its execution. They were all unavailing. The 
paroxysms and the morbid derangements still continued, and the patient's 
constitution became at every period, more and more enfeebled. Her 
existence seemed nearly to have been extended to its utmost limit, and 
death, I may say, had marked her for his own. In this situation electri- 
city was proposed, and from the extreme feebleness which existed, ap- 
prehensions were entertained that the necessary shocks would be too se- 
vere. They were submitted to, however, and the first application was 
found useful in abating the severity of the symptoms. A few repeti- 
tions seemed to unlock the secretions which had so long been retained. 
With the discharge every unpleasant symptom disappeared, and to this 
day the lady enjoys a large share of health. So complete a triumph as 
was thus exhibited, deserves not only to be recorded, but to be remem- 
bered. Its application being connected with so many minute directions, 
which can best be exemplified upon the machine, that I must refer you 
to the Professor of Chemistry. Another case of spasmodic disease, 
closely resembling (Catalepsy, fell under my notice, in which the benefit 
conferred by electricity, was conspicuously manifested. The case de- 
tailed. 

Others of minor efficacy. 
Rosmarinus Officinalis — Rosemary. 
Mentha Puligium — Pennyroyal. 
Monarda Punctata — Mountain Mint. 



68 

[2>] Remedies which increase arterial action by giving tone to 

the system. 

Amenorrhoea being often connected with a debilitated state of the 
system requiring tonics. 

The preparations of Iron have long been considered among the most 
useful and valuable remedies in these cases; and a number of facts 
could be cited, of their utility in diseases which proceed from atony of 
the general system, in cases of feeble re-action, and of languid and im- 
perfect operations of the functions generally. They have, therefore, 
been employed in a variety of cases, which will be more particularly 
considered at a future period. 

In the state of system which is at present under consideration, few 
articles can be more beneficial. Not only are they of use by the im- 
pression which is made upon the animal fibre, but by being received in- 
to the circulating system, the energies of the heart are greatly increased, 
the pulse is rendered more full and strong, greater energy is afforded to the 
animal functions, secretions renewed, and health restored. With these 
changes the process of assimilation is better performed, a more healthy 
chyle elaborated, nutrition advances, and hence, to an increase of vas- 
cular action, is added an increase in the bulk of the body. 

Of the Preparations which have been most esteemed. 

The Proto. Carbonate of Iron — Rubigo Ferri or rust of Iron — deserves 
first to be considered. It is obtained by moistening the filings of Iron 
frequently with water, by which they become oxidated, and are then 
ground into an impalpable powder. During this exposure to the air 
and moisture by which the Iron is oxidated, the oxide is found to be 
combined with carbonic acid gas, derived from the atmosphere. 

This is one of the mildest preparations of iron, and is much resorted 
to. It is seldom given alone ; but it is combined with tonics and aro- 
matics, with a view to improve their action, and to lessen the distaste 
which arises from its uncombined administration. 

Useful Formula for exhibiting this article. Vide Formulae. 

Another and more agreeable formula, is the Chalybeate Wine, prepa- 
red as seen in Chapman's Therapeutics. This preparation I have fre- 
quently employed, and would recommend it to you, as pleasant to the 
stomach, and highly beneficial in its operation. 

In the constitutions submitted to our care, under this condition of the 
system, much attention is required, in adapting the medicine given, to 
the excitability, and so to compound your medicines, that exciting but 
little disgust, their use may be persisted in, until the object intended is 
accomplished. 

Dose, powder, x to xv grs. 

Chalybeate Wine, ^ii to fss. 

Proto Sulphate of Iron — Preparation — a useful and more active arti- 
cle. The sulphate of Iron is frequently given in the form of pills, com- 
bined with the vegetable bitter extracts, as with Cinchona, Gentian, <fec, 
or it may be united to an infusion of Quassia, or Colombo. These 



69 

articles being particularly preferred, as in consequence of their contain- 
ing little or none of the astringent principle, their colour is not changed 
by the addition of the salts of iron. : ••• 

Dose, i to ij grs. 

Tinctura Muriatis Ferri — Preparation — an agreeable and efficacious 
article. By its tonic, united to an astringent operation, it will be found 
useful in immoderate discharges, particularly in Menorrhagia, Leucorr- 
hoea, Gleets, &c. 

Dose, viii to xii m,inan infusion of Colombo or Quassia. 

Another preparation of iron is, the Liquor Hydriod. Ferri. 

A variety of other means are usually resorted to, to restore the tone 
of the system, but they can scarcely be called emmenagogue. It may 
be proper to mention them here. They are exercise in the open air, a 
very powerful means of strengthening the system, and with particularly 
good effects, if the lower limbs can be much employed, as in walking, 

riding on horseback, &c The cold bath of the temperature of 50 or 

60° Fahrenheit — frictions to the lower extremities, and lastly a cordial 
and strengthening diet, which, if properly directed, and caution observed 
with respect to quantity, so as not to oppress the digestive organs, I 
would rank among the best of tonics. 

[c] Emmenagogues which diminish action. 

The suppression of thi3 secretion is often found occurring in full 
plethoric habits, with much arterial excitement, flushed face, inflamed 
eyes, and pains in various parts of the system. Depleting remedies, un- 
der these circumstances, are the best emmenagogues, and of these vense 
section hold the first rank. The uterus, in habits of this description, 
may be considered as partaking of the same plethoric and inflammatory 
state, and the action to be carried to such a degree, as to transcend the 
point of secretion. 

To this may be added other means* of depletion. — Cathartics maybe 
considered as next in value. For the purposes of depletion any of them 
may be employed. A few may be enumerated particularly. 

Family Ranunculacece, — Helleborus Niger. Natural History — Char- 
acter — Dangerous and drastic remedy — rarely employed. 

Aloe Perfoliata — Natural History and operation already considered. 
It is seldom given alone, but is combined with various other articles, or 
administered in the form of Tincture. — Of these preparations, the most 
celebrated, is the 

Elixir Proprietatis, or Compound Tincture of Aloes. It is prepared 
as seen in the Dispensatory. It is a warm, active, and stimulating cathar- 
tic, and is much employed in catamenial obstructions. In the state of 
Constitution under consideration, I have commonly been more successful, 
by administering x to xv grs. of Calomel at bed-time, and in the morn- 
ing, following up its operation with a dose of the Tincture. This prac- 
tice is to be repeated two or three nights, and will often be found benefi- 
cial. 

Hooper's Pills, &c. 



70 

Preparations of Mercury — They are employed, not only as evacu- 
ants, but to renew secretions. — For this purpose their use is continued in 
moderate doses until slight ptyalism is accomplished, and in very obsti- 
nate cases, this course, aided by blisters to the inner parts of the thighs, 
will, in all probability, be attended with beneficial effects. 

Division IX. 
Medicines which promote the secretions from the Bronchial pas- 
sages. 

EXPECTORANTS. 

State of the bronchial secretion in health — in disease — The action of 
this class considered, and the circumstances under which their operation 
is promoted. 

PARTICULAR EXPECTORANTS. 

[a] Depleting Remedies. 

[b] Medicines which have their action upon the stomach, and operate by 
increasing the pulmonary with the insensible secretions of the surface. 

Ipecacuanha and Tartarized Antimony of this character — Given com- 
bined with other articles and in small doses. 

Scilla Maritima — Useful article, particularly in the diseases of child- 
ren — Compound Syrup of Squills. 

[c] Expectorants which operate as stimulants. 

Family Umbelliferaz — Gum Ammoniac. Natural History — Prepara- 
tion — Properties — Employed in Pulmonary affections, where the lungs 
are oppressed by viscid phlegm — In Chronic Catarrhs — In Asthmas, par- 
ticularly the pituitary, or humid — In Pneumonia after action has been re- 
duced — and in Peripneumonia Notha. In any of these cases, it is often 
of essential service in promoting expectoration, and relieving respiration. 

Exhibition — Vide Formula. 

Gum Assafoetida — Natural History described hereafter. Useful in 
Pertussis — Tussis Senilis — Chronic coughs, &c. given in the form of a 
watery solution. 

Dose, 31'i to |ss. 

Polygala Seneka — Expectorant properties considerable — Employed 
in Pulmonic affections after inflammatory action has been reduced — 
when the patient is oppressed with a dry cough or difficult expectora- 
tion — In Cynanche Trachealls as a secondary remedy, and when em- 
ployed, the decoction should be stronger than is usually given. For- 
mula. 

The decoction, when of ordinary strength, is prepared by boiling fss 
fiof the root in water Ibiss to 1 pint, other articles being added to make 
it more agreeable. 

Dose, ^ss to f i. 

Family Companulaceai — Lobelia Inflata — Indian Tobacco; Natural 



71 

History — Properties — Action upon the fauces and the salivary and mu- 
cous secretions — Upon the stomach produces Nausea, and when in 
large doses, vomiting frequently succeeds — Employed in Asthma — In 
the pectoral affections of children — In threatened Croup, for its emetic 
and expectorant properties. 

Dose — Saturated Tincture 3i to jii. 

Children xx to xl m. 
Infusion — 3ss to water 1 pint. 
Dose, fss to f\. 
Syrup for children similar in its effects to squills — 3i to 3 i I - 
Family Liliaceoe — Allium Sativum — Garlic — Natural History — Pro- 
perties — Employed in catarrhal affections of long continuance — Given 
in the form of 

Expressed juice, 31 to fss- 
Syrup of Garlic, a table-spoonful. 
Family Leguminosa — Myroxylon Toluiferum — Balsam of Tolu — Na- 
tural History — Obtained by making incisions into the bark of the tree, 
from which it exudes in considerable abundance — Analysis — Useful as 
an expectorant, when vascular action has been reduced, or when little 
excitement exists — Employed alone, or more commonly united with 
other articles. Formula. 

Hill's Balsam of Honey — a preparation of this article, useful in the 
chronic coughs, and pectoral affections of old people. 
Dose, Tinct. Bals. tolut. 3i to jii. 

Balsam, 3ss suspended in water by mucilage or 
' honey. 
Myroxylon Peruiferum — or Peruvian Balsam. Natural History — Ob- 
tained by incisions made into the bark of the tree — Analysis — Employed 
as the preceding. 

Doses the same. 
Copaifera Officinalis — Balsam Copaiva — To its other properties must 
be added its very valuable operation in the chronic stages of Pulmonary 
affections — As Chronic Catarrh — In increased discharges from the mu- 
cous membrane lining the bronchise, &c. 
Dose, xx to xxx m. 
[d] Articles which allay irritation of the mucous membrane, lining the 
larynx and trachea — the existence of which excites coughing. 

Family Leguminosoe — Glycirrhiza Glabra — .Liquorice — Natural His- 
tory — Preparation of the Extract — Employed in Catarrhal and Pulmo- 
nic affections — In coughs, hoarseness, &c. combined with other articles. 
Formula. 

Mimosa Nilotica — Gum Arabic. Natural History — Manner in which 
obtained from the tree* — varieties to be met with in commerce — Most 
valuable of all the gums and mucilaginous substances — Useful adjuvant 
to other substances in the formation of Pectoral mixtures — and for al- 
laying irritation in various parts of the body. 

Family Lineaceai — Semen Lim — Flax Seed. Natural History — Much 
employed as the preceding. 

Decoction of the seeds sweetened with honey, and acidulated. 



72 

Inhalations. 

General Remarks — Mildest, vapour of warm water — of Vinegar and 
water — More stimulating — Spirits, impregnated with other substances— 
•'.Fumes of Tar — Rosin, &c. 
Pneumatic Medicine. 

Division X. 

epispastics. 

History of the employment of blisters — Phenomena arising from their 
application — The modus operandi of blisters, in the cure of diseases— 
To give to this subject all the importance it deserves, the structure and 
relations of the skin briefly considered. The beneficial effects of this 
class arranged under the three following divisions: 

[a] Where the actions of the system threaten to become too weak. 

Their utility exhibited in the several forms of febrile diseases — In Ty- 
phus and other continued Fevers — In remittents — In the advanced sta. 
ges of inflammatory fevers. 

[b] Where they are irregular. 

As in convulsive affections— In apoplexy — Mania — In affections of 
the alimentary canal — Cholera — Colic — Diarrhoea. 

[c] Where they are partially too strong. 

As in all local inflammatory affections — The proper period for the ap- 
plication of blisters considered — The connections of the skin with the 
general system concluding these remarks. 

ARTICLES COMPOSING THE CLASS EPISPASTICS. 

Cantharis Vesicatoria — or Spanish Fly. Natural History — Manner 
of collecting and preserving the Flies — Analysis — Cantharidin — Prepar- 
ation of the ointment, size and shape of the plasters when applied to 
particular parts — Their proper application — Parts of the body selected 
when their general operation is to be obtained — when the local — Dres- 
sing of blisters. 

Their effects upon the Constitution, particularly the urinary bladder — 
producing strangury — Treatment: 

Lytta Vittata, or Potato Fly — Natural History. Effects as the pre- 
ceding. 

Nitric Acid — Employed in diseases which are violent and rapid in 
their course, for the production of speedy vesication — Thus used in the 
Cholera Morbus of India — In the low states of fever — In comatose af- 
fections, and in cases where the ordinary process of blistering is resis- 
ted. 

Manner of applying the acid. 

Rubefacients— Their general effects, and cases in which they are use- 
fully employed. 

Family Crucifera — Sinapis or mustard — The very beneficial effects 



73 

derived from it in disease, in the form of Cataplasm, as a stimulating and 
revulsive remedy. The seeds administered in several diseases with re- 
suits not very decisive. 

01 : Terebinthinee — Very useful article, commonly employed combi- 
ned. Formula. 

Issues. 

Setons and Caustic Issues — Useful auxiliary in several chronic dis- 
eases — In Pulmonic affections, Chronic Hepatitis — Dysentery — Hypo- 
chondriasis — In obstinate Leucorrhsea, Menorrhagia, &c. applied near 
to the seat of the disease. 

Division XL 

Medicines which promote the secretions generally , and particu- 
larly the salivary. 

SIALOGOGUES. 

External or Masticatories. 

Internal — Hydrargyrum, or Mercury. 

Natural History. It is an opaque silver coloured metallic fluid, ap- 
pearing to the eye like melted lead, solidified by extreme degrees of 
cold, and capable of being evaporated by a heat below ignition. It is 
found in the bowels of the earth sometimes pure, and is called Virgin 
Mercury, but most commonly it is combined with sulphur, or earthly 
matters, from which it is purified by processes to be explained by the 
Professor of Chemistry. The principal mines of quicksilver, of which 
we have any account, are in Spain, Hungary, Peru, and considerable 
quantities are brought also from the East-Indies. 

Medical History. This fluid, supposed by the Greeks, to be poi- 
sonous, urged its way into practice with considerable difficulty. Thus, 
Diascorides ascribed pernicious effects to it in Medicine, and the elder 
Pliny declared, that it had the quality of poisoning all things. These 
opinions of the nature of Mercury, influenced Galen to consider it 
highly corrosive, and to rank it among the poisons. The writings of 
Galen, circulating among the Arabians, the correctness of these opin- 
ions became questioned, and we find their most distinguished physicians, 
as Rhazes, Avicenna, introducing it into Medicine, as an ingredi- 
ent in external applications in different cutaneous diseases. Shortly 
after this period, Avicenna having observed, that even when taken inter- 
nally, it caused no injurious effects, and that by its weight, it made a free 
passage through the bowels, the practice became common to give it 
largely in affections of the Intestinal canal, and in cases of difficult la- 
bour. 

The researches after the philosopher's stone, and the chemical doc- 
trines, being coeval with this period, we find mercury occupying the prin- 
cipal attention of the philosophers of that sect, and being the substance 

10 



74 

upon which their hopes were chiefly directed. It was accordingly, sub- 
jected to a variety of processes, and in the zeal for discovery, its pro- 
perties became better known. The practice of the Arabians, was fol- 
lowed by some physicians in Europe, towards the end of the thirteenth 
.century, but was not established or looked upon, in general, to be safe, 
until about the beginning of the sixteenth, when the venereal disease ma- 
king its appearance in Europe, was found to yield to mercurial prepara- 
tions alone. By the bold and vigorous use of them, Paracelsus and Van 
Helmont, made known a practice far more successful than any of their 
predecessors, and contributed, very much, to extend the reputation of this 
article. Being found so efficacious in the venereal disease, its use began 
to be be ventured upon in other complaints. To Dr. Chisolm in the 
West-Indies, and the Physicians of this country, we owe its extensive 
use in malignant fevers, and' the diseases of warm climates. 

Chemical History. In its crude state, it produces no perceptible ef- 
fect on the body, and is without any sensible acrimony, taste, or smell, 
yet it may be rendered active, by changes in its chemical state, or addi- 
tions to its substance. When rendered thus active, it seems to be a stim- 
lus to every sensible and moving fibre of the body to which it is applied. 
The degree of its stimulant impression, is modified in a very remarka- 
ble manner, by the different preparations of it which have been proposed 
and employed. In consequence of the changes which it undergoes by 
its numerous preparations, it is not only a powerful stimulant, but it enters 
the circulation, quickens the vascular action, excites powerfully the 
whole glandular system, and increases all the secretions and excretions. 
Hence, it happens, that its various preparations produce different effects, 
operating sometimes as stimulants to the general system, or as cathar- 
tics, emmenagogues, errhines, &c, and hence it becomes useful in a 
great variety of diseases, such as febrile affections, cachectic diseases, 
glandular obstructions, and cutaneous eruptions. 

The value of these preparations may be inferred from this circum- 
stance, that during a period of 300 years, experience has fully sanc- 
tioned their use; and in confirmation, I may adduce the remark of Mr. 
Pearson, who justly observes, that no one medicine besides, (opium ex- 
cepted,) derived from the animal, vegetable, or mineral kingdom, has 
maintained its credit with men actually employed in extensive practice, 
during a tenth part of that period. Although it is a medicine capable of 
being abused to the disappointment of the patient, and to the injury of 
the constitution, yet under the direction of cautious and judicious practi- 
tioners, it may be ranked as one of the most useful articles of the M. M. 

The chemical changes which have been proposed, in order to render 
mercury active and useful, may be reduced to oxidation in different de- 
grees, and union with acids, constituting mercurial salts. 

The Preparations of Mercury, may be considered under the three 
following heads : 

1. As they are formed by Trituration. 

2. As they are combined with Sulphur and Todine. 

3. As they are combined with acids of different kinds, forming salts. 
The Preparations by Trituration, are formed by rubbing Mercury 



75 

with Saccharine, Mucilaginous, or other substances, until the globules of 
mercury are completely divided. By this operation, the mercury being 
exposed to the atmosphere, becomes oxidised. They are more mild 
than the preparations formed by a combination with the acids, but to be 
effectual, the trituration should be complete, otherwise the practitioner 
will experience uncertainty in their use. 

The first of the Preparations under this head, is the Pilula Hydrar- 
gyri or Blue Pill. 

Preparation. This is one of the best preparations of mercury, and 
may, in general, supercede most of the forms of this medicine. In its 
preparation the mercury is minutely divided and converted into the 
black oxide. Present a specimen of the blue mass manufactured by 
steam power, being in a more minute and oermanent division — also of 
the protoxide of mercury as it exists in the blue mass. 

The blue pill is much employed to produce a mercurial impression on 
the system, sometimes to act as a laxative. For these purposes it is 
much less active than calomel, but possesses this advantage, that it may 
be administered to irritable subjects, who are purged, or otherwise in- 
commoded by the Proto-Chloride of Mercury. Employed in the treat- 
ment of various affections of the stomach, and chylopoietic viscera. 
Dose, iv to vj grs. 

One grain of mercury is contained in four grains of the mass, accor- 
ding to the Edinburgh formula. 

Do. in iij of the London. 

Do. in ij of the Dublin. The first is preferred. 

Mistura Hydrargyri Mucilaginosa. 

This is the second preparation formed by trituration, in which the mer. 
cury reduced to the state of a dark grey oxide, is combined with gum 
or vegetable mucilage. Called also Plenck's solution, from being intro- 
duced into use by Professor Plenck. Preparation. This is an inconve- 
nient mode of exhibition, as the mercury does not remain sufficiently 
suspended — but rarely employed. 

Unguenlum Hydrargyri — or Mercurial Ointment — Preparation — Mer- 
cury exists in the ointment partly oxidated, and partly in the state of 
minute mechanical division — Employed in the form of friction when the 
other preparations disagree with the bowels, producing griping, purging, 
&c.,and where it is desirable, to produce a prompt operation upon the 
system. Used for the discussion of tumors, buboes — In Erysipelas. 

Preparation of the patient before commencing the frictions. 

3i, the ordinary quantity to be rubbed into the inner part 
of the thigh, groins, and genitals, or inner part of 
the arm and axilla. 

Hydrargyrum cum Creta — Preparation — Employed with advantage in 
the disordered condition of the first passages occurring in children, ex- 
hibiting, as they often do, an altered and morbid condition of the secre- 
tions — being either [a] of a greenish color, or clay colored, or white, or 
[6] as regards consistence thin and watery, or curdled, or slim3 r — or [c] 
as relates to odour, either highly offensive, or of an earthly smell — Under 



76 

the above circumstances, small doses of this preparation will be found 
very beneficial. 

'_.-♦. Three grs. of the Hydrargyrum cum creta contain 1 gr. of Mercury. 
v*v Dose, ij to iv grs. 

[b] In combination with Sulphur. 

Black Sulphuret of Mercury — iEthiops Mineral — Preparation — rarely 
employed. 

Red Sulphuret of Mercury, or Factitious Cinnabar. Preparation— 
Rarely employed internally, but chiefly used in fumigations to sores of a 
syphilitic character, or chronic ulcerations. Remarks upon Mercurial 
fumigations. 

[c] Preparations of Mercury by Acids. 
Proto. Nitrate of Mercury, or Red Precipitate. 

It is prepared by dissolving Mercury in Nitric Acid, and exposing the 
Nitrate formed, to a temperature just sufficient for expelling the whole of 
the Nitric Acid. It is commonly known by the name o( Red Precipi- 
tate. 

This preparation is seldom used internally. It is not calculated to ful- 
fil any indications, which cannot be obtained by the Protoxide, and is lia- 
ble to act violently upon the stomach and bowels, sometimes in doses 
of a grain only. Its exclusion, therefore, from internal use, is recommen- 
ded. 

Externally, it is employed for various purposes, to cleanse ulcers, and 
to stimulate them to action, and to repress exuberant granulations — also 
employed in Herpetic affections, Chronic diseases of the skin, Taenia 
Capitis, Chancres, &c. Vide Formulas. 

Sub deuto Sulphate of Mercury or Turpeth Mineral — Preparation. 
Properties. 

It is too harsh for general use, and is seldom employed. Its action is 
not confined to tbe prima vise, but is very apt to produce salivation, if a 
cathartic is not employed soon after. 

Sub Murias Hydrargyri et Ammonia — The Ammoniated Submuriate 
of Mercury — White Precipitate. 

This article is only used externally, in the form of ointment, in the 
proporton of ^i of the Salt to fi of Lard, in obstinate eruptions, herpetic 
affections, &c. 

The combinations of Mercury with Chlorine, are the most valuable 
and efficacious remedies the M. M. affords. They form the Per. and 
Proto. Chloride of Mercury. 

The Perchloride of Mercury, is formed, by subliming a mixture of 
the Bi Sulphate of the Peroxide of Mercury, or Turpeth Mineral, with 
the Chloride of Sodium — the Perchloride of Mercury being formed du- 
ring the process. 

This is the most corrosive, and the most acrid preparation of mercury, 
with which we are acquainted. It was first introduced into practice by 
the celebrated Van Swieten, and by him recommended in the form of al- 
coholic solution. 

Antivenereal properties considered — Employed with most advantage 
in the concluding stages of syphilis — Given in small doses, and in com- 
bination with the vegetable alteratives — In cutaneous diseases, obstinate 



... 



77 

ulcerations — Chronic inflammations generally — Form of administra 
tion — Formula. 

In various Chronic affections, especially chronic inflammations, I 
mentioned in a former lecture, that it was a very valuable article cam-* 
bined with the vegetable alteratives, particularly sarsaparilla, and in these 
cases is given in very minute doses, 1-3 to 1-2 of a grain in a pint daily. 
That it was to be continued as long as it was thought necessary, taking 
care to watch its effects upon the mouth, and always keeping in view, 
that mercury given in excess, will tend to increase, rather than destroy 
constitutional irritation. The value of this combination may be inferred, 
when I mention to you, that I believe Swaim's Panacea owes its efficacy 
to the union 'of these substances, and when you consider the numerous 
and diversified affections in which this medicine has been employed, and 
the beneficial effects which have generally been derived. I have intro- 
duced this subject again to your notice, as much with a view to bring to 
your recollection what was then said, as to inform you, that the suspi- 
cions which I expressed of the composition of the medicine, have been 
confirmed by conversation with several gentlemen. The composition 
had been investigated by Professor Hare, and others, and from the evi- 
dence of circumstance, there could be little doubt on this subject. So 
general was the belief, that most of the Physicians of Philadelphia 
were in the habit of preparing it for themselves. 

The Perchloride of Mercury may be given in the form of pill, or dis- 
solved in spirits — Formula. 

The Perchloride of Mercury dissolved in a Tincture of Cinchona, in 
the proportion of ij grs. to an ounce, and given in doses of x or xv drops, 
according to the age of the patient, twice a day, will be found a valuable 
medicine in the Chronic diseases of children, and with particular good ef- 
fects, in those cases where there is enlargements of th*e mesenteric glands. 
Many of the empirical remedies, which are boasted of as curing syph- 
ilis without mercury, owe their efficacy to this substance. The dose 
being small, is easily disguised with other articles with which it is mixed, 
and it is less liable than the other preparations of mercury to excite 
ptyalism. 

Externally it is employed for various purposes. 
In combination with Lime-water, it forms the Yellow-wash, so much 
recommended in the treatment of obstinate and ill-conditioned ulcers. 
Dose, the 1-8 to 1-4 of a grain. 
Poisonous operation of the Perchloride — Effects upon the system in 
large doses. Treatment to be pursued. Antidotes — The best is albu- 
men, or the white of eggs beat up with water, and taken in large quantity. 
It decomposes the corrosive sublimate, and forms a triple compound, 
consisting of albumen, muriatic acid and calomel — An ounce of the 
white of eggs is required to neutralize 3 grs. of the corrosive sublimate. 
Protochloride of Mercury. It is prepared by rubbing purified Quick- 
silver with the Perchloride of Mercury until the globules disappear. It 
is then sublimed in a glass mattress, or florence flask. When sublimed, 
it is reduced to powder, and well washed for the purpose of separating 
any portion of corrosive sublimate which may have been formed in the 



78 

process. It is again sublimed, and washed — corrosive sublimate being 
soluble in water, and calomel insoluble, this is a ready mode of separa- 
ting them. 

"This is the most important and the most extensively employed article 
. in the whole range of the M. M. It is capable of fulfilling more indica- 
tions, and of being applied advantageously to a greater variety of dis- 
eases than any other article which is furnished by the vegetable or mine- 
ral kingdoms. It is anti-syphilitic, anti-spasmodic, alterative, deobstru- 
ent, purgative, errhine, sialogogue, and anthelmintic. 

General operation of Calomel on the system — Mercury when rendered 
active by Chemical changes, as in the state of an oxide, or neutral salt, 
seems to be a stimulus to every part of the system. When taken into 
the system it manifests itself by a quickened circulation, gives the blood 
the disposition to take on the buffy coat when drawn, renders the pulse 
frequent and harder, increases respiration, excites the temperature of the 
body, occasions a whitish fur on the tongue, and other symptoms of 
general inflammatory action — (Francis.) 

It seems also to be a stimulus to all the excretories of the body, of 
the salivary glands, of the trachea, lungs, digestive organs, the chylopoie- 
tic viscera, and the whole alimentary canal. 

It is slow in its operation, but when accumulated in the system to a 
sufficient degree, its action is exhibited in the production of such excite- 
ment, as to be called Morbus Mercurialis, during which the functional 
operations of all the systems of the body, are quickened and excited to a 
very great degree — (Francis' Inaugural Dissertation.) 

It is these various and diversified powers, which give to mercury its 
very great superiority, and as particular effects are produced by regu- 
lating the dose, it becomes a remedy very generally applicable to dis- 
eases. 

The good effects of Mercury in Fevers depend, 

1. On its power of evacuating bile, fseces, and the morbid secre- 
tions of the alimentary canal. It is well known, that in malignant fe- 
vers, the Intestines are loaded, not only with increased quantity, but a 
vitiated quality of all the secretions which are poured into them. These, 
by retention, are not only increased in the degree of their morbid quali- 
ties, but by their accumulation become, in reality, exciting causes of 
disease. They have been known to possess such a degree of acrimony, 
as to excoriate the rectum, and the skin of the neighbouring parts. For 
the removal of these acrimonious matters, the milder cathartics, as the 
neutral salts, &c. have been resorted to, for fear of increasing the debili- 
ty which exists. But Calomel alone, though generally in combination, 
surpasses all other cathartics, not only evacuating the contents of the 
bowels, but by exciting the several glands which empty into them, to a 
free and copious discharge, changing the character of their vitiated se- 
cretions, relieving topical congestions, and by removing the causes which 
indirectly debilitate, the patient is strengthened. 

2. The good effects of mercury in the cure of fevers, depend upon 
its exciting a new action in the vessels, or one different from that which 
constitutes the proximate cause of the disease, and accordingly, we find, 



79 

that as the mercurial action begins to exhibit itself, the symptoms of the 
original disease subside. This action commences with the approach of 
salivation, which seems to be the test of the mercurial impression. The v» 
fact of the original disease giving way, upon the approach of the Merctt-'* ^ 
rial, is so well established, that it hardly seems necessary to adduce 
proofs. For your satisfaction, I might detail the opinions of the most 
distinguished advocates of the mercurial practice on this point, of Drs. 
Rush, Chisolm, Clark, Warren, and others. 

Application of Calomel to the cure of diseases. 

In Yellow-fever — The Practice of several Physicians stated — of 
Warren, Chisolm, Clark, and of the resident Physicians of Charleston, 
during the several seasons that it has appeared as an epidemic. 

I would not wish to be understood that the mercurial is the only prac- 
tice which is to be pursued. I am on the contrary, most favourable to the 
employment of general and local blood-letting in this fever, the use of the 
cold effusion, purgative, and diaphoretic medicines, with blisters, and the 
benefits to be derived from a rigid system of abstinence, when that pecu- 
liarly irritable and inflammatory condition of the stomach takes place, 
which precedes and accompanies the black vomit. With these means 
I have combatted this severe disease, and my practice, I have had reason 
to think, was as successful as most of my medical brethren. 

In severe cases it was observed, that the high excitement of the sys- 
tem, resisted the mercurial action, and though employed in large doses, 
and repeated at proper intervals, yet it failed to produce its specific effects, 
and death was often the consequence. In other cases where this ex- 
citement was less violent, the peculiar effects of the mercury were pro- 
duced, and with the ptyalism and gradual subsidence of all the symp- 
toms took place. In these cases, I have every reason to think, that 
equally beneficial effects follow from the practice just mentioned — and 
on some accounts it was preferable, as patients in their convalescence 
were not distressed with the disagreeable effects of sore mouths, swelled 
tongues, &c. The mildness of the particular case, as Bright and Addi- 
son observe, permitted the usual operation of the remedy, rather than, 
that the remedy controled the fever. 

In the Bilious Remittent, or Country-fever. The beneficial operation 
of this medicine in these cases, may be inferred from what has been said 
of the peculiar operation of this article, in another place, upon the ali- 
mentary canal and the chylopoietic viscera. To the advantages arising' 
from the use of mercurials in this form of fever, it may be added, that 
relapses are less likely to follow, than where the purgative and diapho- 
retic course is pursued. Exercising an influence so powerful as this 
medicine does, and in the several modes I have pointed out, I still think, 
that in the very acute diseases of our country, it is not alone sufficient. 
In this disease as well as Yellow-fever, blood-letting at the commence, 
ment, is of the utmost importance in diminishing action, lessening undue 
determinations, reducing inflammation, and other effects, of which I 
have already spoken. Neither can we depend upon Calomel as a cathar- 
tic, for in these acute cases its operation is too slow, and the sufferings 



of the patient require that prompt measures be enforced. It is proper, 
therefore, to alternate its use with the saline cathartics, and this course 
continued until the disease begins to decline, or the mercurial prepara- 
tions to exhibit their effects upon the system, either in improved secretions, 
or if still further continued, in its impression ujfon the gums and salivary 
glands. 

While I thus advocate the use of this article, I cannot too earnestly 
caution you in the administration of it. Salivation is always painful, 
and very distressing, to convalescents. All that is required, is a gentle 
mercurial impression to the extent of producing tumefaction of the gums, 
and a slight spitting. This is what most practitioners will allow, is all 
that is to be desired. Yet, from a careless employment of the medi- 
cine, the sialogogue operation often takes place, to a great, and even 
alarming, degree. It is, therefore, important, that you should be infor- 
med how it may be obviated, and by attention to a few rules, you will, 
in most cases, succeed. 

Rule I. In those cases where Mercury is employed, examine the 
evacuations of your patient, as soon as they are changed either from a 
dark, ash or grey color, to the color of bile — or their consistence from 
being thin and water}', to a more natural appearance, which will always 
take place when the liver pours forth a more healthy secretion, the medi- 
cine should be discontinued, or given at longer intervals. 

Rule II. By omitting the use of the Medicine as soon as it exhibits 
the first indications of action upon the gums. These are redness, a pe- 
culiar faetor upon being rubbed, and a slight ulceration about the teeth. 

Rule III. By attending to the constitution of the patient. The siala- 
gogue operation of Mercury is very badly borne by persons of delicate 
habits, in whom the nervous temperament chiefly prevails. It is badly 
borne by persons advanced in life, whose constitutions have been impair- 
ed by previous attacks of sickness, and who are, therefore, weak and en- 
feebled. 

Rule IV. The sialagogue operation of Mercury should not be at- 
tempted in persons under twelve years of age. By attending to these 
rules, severe instances of salivation will be prevented from occurring, I 
will not say invariably, but in a great majority of cases. . Only observe 
the same precautions with this medicine, which are used with other active 
articles. We discontinue the use of opium when sleep is induced, 
Digitalis when it affects the brain and the organ of vision, Arsenic when 
it produces intumescence of the cellular membrane, and Calomel when 
it changes the secretions. This is sometimes difficult to be discovered, 
but attention is, on that account, the more necessary, particularly as its 
effects are more lasting, and distressing. 

In Typhus-fever. In many of the Phlegmasia?, it has been recom- 
mended and employed, as Hepatitis, Pneumonia, Rheumatism — in In- 
flammatory affections of the Throat, Larynx, Bronchia?, Phthisis Pul- 
monalis — In Intestinal affections, as Dysentery, Dyspepsia, Cholera 
Morbus, the Intestinal derangements of children — in Tetanus, Dropsies, 
Syphilis. 



81 

Morbid effects produced from the use of Mercury. The first disease 
to be noticed, is the Erethismus Mercuriale,'or Eczema Me'rcuriale, or 
Hydrargyrium. 

Description of the disease — Mr. Alley's plates exhibited. 

Another of the morbid effects of mercury is salivation. This affection 
is often a most unpleasant consequence of the employment of mercurial 
preparations, and sometimes, by its violence, a more distressing disease 
than the original complaint. The only mode of preventing these effects, 
is to exercise great caution, and to watch the progress of symptoms. 

When the disease is formed, the Treatment will be directed, first, to 
the mitigation of pain. 

This is afforded by washing the mouth with a solution of opium, either 
in water or milk — a strong infusion of green tea with laudanum — a so- 
lution of the acetate of lead, with laudanum. To these may be added 
leeches, ice water. 

When sloughing exists, a solution of the chloride of soda may be re- 
sorted to, or the pyroligneous acid, or kreosote diluted. Emetics have 
been considered useful in counteracting the inordinate effects of mercury. 
Iodine has also been employed — A free exposure to dry cold air — A 
gargle of the root of the rhus glabrum, &c. 

The second object to be pursued is, to determine the fluids to other 
parts. Cathartics are among the means resorted to for this purpose — 
Sulphur has been recommended, but with no particular advantage— ^-Blis- 
ters. 

The third object to be pursued is, to heal the local injury by restoring 
the tone of the parts. This is done by astringent gargles, composed of 
red rose leaves, red oak bark, a decoction of galls with a little alum. 

Division XII. 

Medicines, the effects of which are exhibited on the system 

generally. 

Under this division are comprised Stimulants or Incitants properly so 
called — Narcotics — Antispasmodics— -Tonics — and Astringents. 

STIMULANTS. 

Produce their effects by an impression upon the nervous energies of 
the stomach, which being communicated to the sensorium, is thence dif- 
fused over the system. The operation of these substances is too rapid, 
to admit of the supposition of their introduction into the circulation. 
By the impression upon the stomach, through the medium of the nerves, 
the vital energies are excited, as is evinced by the activity of the men- 
tal arid corporeal powers, the increase of the force and vigour of the 
pulse, by the general determination of blood to the surface of the body, 
producing heat, flushing, and even perspiration. 

From a knowledge of their effects, we judge of the diseases in which 
they are applicable. Employed with caution, they become very valua- 
ble in those cases of debility, succeeding fevers, or other violent dis- 
eases, when morbid action ceases, and no organic disorder remains. 
11 



82 

At the present time it is so fashionable to attribute diseases to inflam- 
mation, that it might almost be questioned, whether such a class as stimu- 
lahts should be retained. I confess that I am not so much a convert 
■ jto'the physiological system of medicine, as to admit of their exclusion 
from practice. I still however consider, that they are less necessary, 
and that their administration should be more cautiously regulated, than 
,-, has been usual. This is more particularly the case, when we reflect 
Tj that all the symptoms of prostration may be produced from irrita- 
tion, or inflammation, of particular organs. Take for example Typhus, 
and the low forms of fever generally. The symptoms most commonly 
characteristic of these diseases, arise in lesions of the cerebral, spinal, 
and nervous systems. Inflammation of these systems is followed by 
great prostration of strength, frequent pulse, excited skin, depraved se- 
cretions, stupor, coma, convulsions — and it is for the relief of these very 
symptoms, that stimulants are frequently employed. 

There are other cases, however, where Typhus is strictly adynamic, 
and in which the free use of stimulants becomes necessary. These cases 
are however rare, compared with the acute forms of the disease. The 
symptoms are, great prostration of the nervous and muscular energies, 
delirium, haemorrhage, scattered petechise, soft fluent pulse, heat of skin 
little increased or below par. Under these circumstances, it is neces- 
sary to administer stimulants, and often to a considerable extent. 

It is obvious, therefore, that in the employment of these medicines, 
much discrimination is required, and that until a correct diagnosis is 
drawn, mischief rather than benefit must arise from their use. The prac- 
titioner, therefore, should make himself acquainted with the pathology of 
diseases, and that he may be guided in his researches, he must have re- 
course to the productions of the French school. He will be much assis- 
ted by Goupil's exposition of the modern doctrines — Broussais on chro- 
nic inflammation, and Louis on gastro enteritis. 

But though stimulants are improper while inflammation exists, yet they 
become proper at its decline, to put an end to the relaxation, and inaction, 
which occur in parts that have been long stimulated. Under these cir. 
cumstances, the powers of the constitution languish, the circulation is 
feeble, and the digestive function is weak. The functions here are ma- 
terially assisted by a supply of gentle stimulation, and it is then that they 
are useful and safe. 

PARTICULAR STIMULANTS. 

Sub Carbonas Ammonia — Concrete volatile Alkali. Preparation — 
Properties. Employed in low and malignant forms of fever, and in 
such as are called putrid. Formula. In Typhus Pneumonia, but with 
caution; In Cardialgia depending upon acidity ; In gastric affections 
succeeding habits of irregularity and debauch ; In Rheumatism combi- 
ned with the Tinct. of Guaiac, &c. : In the bites of venemous reptiles. 
Used also as an external application. 

Dose, grs. v to x in Julep or Pill. 

Camphor — Substance peculiar in its operation on the system — Much 



83 

employed in low and malignant forms of disease, alternated with the vol. 
alkali. Formula — In Gangrene — In eruptive fevers to promote the filling 
of the pustules, and to bring them back after they have receded — In In- 
flammatory fevers after action has been reduced, combined with relax- 
ing diaphoretics — In several chronic disorders combined with other 
articles — In Mania-a-Potu — External employment. 
Dose, grs. v to 3i. 

Family Coniferce — 01. Terebinthinse Rect — Natural History — Pre- 
paration — Very important article — Employed in Puerperal Fever — Pro. 
duces its good effects in these cases, by exciting a copious secretion 
from the whole internal membrane of the intestines, by which irritation 
is determined from the peritoneum — To this may be added what has 
been termed a specific property in itself, by virtue of which it operates 
as an antidote to the morbid action which exists. Epilepsy — Chronic 
Rheumatism — In obstructions of the bowels combined with Castor Oil — 
As an Anthelmintic — In Chronic Pulmonary affections, in Gonorrhoea, 
Leucorrhcea. 

Dose, from 3i to fii 

3i or less in chronic pains of limbs, chest or elsewhere. 

3ii to ^iij in Epilepsy, Puerperal fever, Obstructions of 

the bowels, against Lumbrici. 
f i to fii — Taenia. 

Alcohol and its combinations — In the former state seldom if ever used 
internally, but is employed externally for several purposes — Diluted as 
it exists in wine, it is of essential importance in Medicine, being more 
agreeably exciting — more refreshing to the patient, and more readily re- 
tained than any other article. Its stimulant operation is more perma- 
nent ; it does not exhaust excitability in any great degree, and may be 
considered in comparison with ardent spirits as exerting a tonic opera- 
tion. 

The diseases, therefore, in which wine is applicable, may be readily 
supposed to be of the typhoid nature, when the indication is to support 
the strength of the patient, and to obviate symptoms of debility. 

There are circumstances in the constitution of the patient, or the 
disease, which plainly forbid its use. In advising it, therefore, its effects 
are to be duly considered. If it does not increase the fever, restless- 
ness and raving, if the sick are refreshed, composed, and inclined to 
sleep by it, have greater freedom from their sickness, or are better sup- 
ported under it, the conclusion is, that it must be a safe, and suitable 
remedy, and without fear we may direct its use, in such quantity, time, 
and manner, as the disease seems to require, and the sick can bear. 
If it produces effects the contrary to them, we may safely conclude that 
it is injurious, and that it ought to be abstained from, or given in mode- 
rate quantities. Thus carefully exhibited, wine will be found not the 
least important of the stimuli, at a proper period in these diseases. 

The quantity of wine, which should be administered in typhus, or 
other febrile affections, when a feeling of sinking, or prostration exists, 
must of course depend upon the symptoms and the degree of action ex- 
isting in the system. 



84 

The choice of wine is not a matter of indifference. To obtain the 
Medicinal effects of wine, a preference is commonly given to Port, as 
being less disposed to acidity. When this cannor be obtained, good 
Madeira will be found to possess every quality, which is necessary to ex. 
cite action, and to supply the pabulum, upon which this action is to be 
maintained. Next to these is Sherry. As a general rule, it will be 
found advisable to allow the sick their favourite wine. 

When wine cannot be procured, cider, porter, or spirits diluted with 
water, sweetened and acidulated, are tolerable substitutes. Dr. Cullen 
was of opinion, that the last mentioned compound and opium, produced 
all the effects of wine ; but opium does not appear to support the pulse 
like wine. 

Poisonous operation of ardent spirits. Treatment. The practice in 
many respects similar to that recommended where an over dose of Lau- 
danum has been taken — substituting the aqua ammonia largely diluted, 
or the acetate of ammonia in the form of mixture, in place of coffee- 
lime juice, &c. recommended to counteract the effects of Laudanum. 
The degree of danger arising from ardent spirits, will be estimated by 
the inirritability of the iris, and the want of energy in the stomach to 
expel its contents. If this last can be excited, the patient will recover, 
but if it cannot, death is usually the consequence, since it is to be presu- 
med, that the stimulus has been so powerful as to bring on a fatal state 
of collapse, by which the powers of vitality are exhausted — and instan- 
ces are not rare, of persons falling dead instantaneously by swallowing a 
large quantity of spirits. 

Morbid appearances—are engorgement of the vessels of the brain, 
and a quantity of serum, in the lateral ventricles. 

Family Solanacece — Capsicum Annuum — Red Pepper — Natural His- 
tory. Analysis — Capsicin — Employed as a condiment. Used also in 
certain stages of Dyspepsia — In Cynanche Maligna in the form of gar- 
gle. Also in that deranged condition of the mucous membrane of the 
stomach which accompanies the black vomit, but with little effect. Pro- 
posed also in febrile disease for its stimulant and diaphoretic properties. 
Among the properties of this article, not noticed by writers, is its 
antilithic. I have only the authority of a single case in speaking 
of it, and probably my observations may be premature. But I am 
acquainted with an elderly gentleman, upwards of seventy years, 
who has been distressed for several years with calculi or gravel. He 
has tried a variety of remedies, with occasional and temporary relief. 
Among the means he employed, was the use of active cathartics, and 
though affording much benefit, yet the operation was too exhausting to 
be long borne. From the feeling of sinking, with the gastric derange- 
ments attending, he was induced to make trial of Capsicum. Since 
using the article, he is fully impressed with the belief, that his life has 
been prolonged, being freed from flatulence, heart-burn, loss of appetite, 
irregularity in the evacuations, which were so distressing. 

The quantity he uses is very considerable, employing at his dinner 
five or six peppers, cutting them up as salad, and mixing them with the 
food eat. The effect of this treatment by restoring his appetite, has 



85 

been to restore his strength, and while promoting the functions of the 
bowels, giving to them greater regularity, it exerts also a diuretic opera,, 
tion. He also thinks some change has taken place in the structure of 
the calculi, that they are softer, more readily broken down by the mus- 
cular actions of the urethra, and expelled in a more pulverulent state. 

Given in the form of infusion. 

In Powder. 
Family Piperinece, — Piper Nigrum or Black Pepper. Natural His- 
tory. Analysis — Oil — Piperin — Employed as a stimulant and carmina- 
tive for several purposes : In Intermittent Fevers. Useful as a gargle 
in relaxed states of the Uvula, and in certain ulcerations of the throat. 

Dose, v to viii of the seeds twice a day. 

Powder, gr. iv to 3i. 

Oil, i drop, 

Piperine, 1-2 to i gr. 
Piper Cubeba — Cubebs. Natural History — Properties — Analysis — 
Employed in Gonorrhoea and Leucorrhoea, alone or combined with Co- 
paiva. Formula. 

Dose, jss to sii of the powder 

Zi to fss of the tincture 

Oil Cubebs m viii 

Enema, 3vi to 3viii of the powder, combined with .mucil- 
age and administered to the patient. The practice 
repeated for several days. 

NARCOTICS. 

The next class of stimulants, is that termed Narcotics. 

Definition of the class and their general effects. The action of the 
Narcotics is principally directed to the brain and nervous system, and 
hence may be called sensorial stimuli. As the other stimulants exhibit 
their effects upon the circulation primarily, and the brain as a secondary 
operation, these on the contrary exert an influence upon the intellectual 
and nervous systems, exciting to their increased activity, and as a con- 
sequence a diminution of their sensibility and irritability. To this pecu- 
liar destination of their powers are we indebted for the beneficial effects 
which they display in diseases — powers which entitle them to be consid- 
ered the best gifts of Heaven to its fallen creatures. It is from the ac- 
tion of these articles upon the brain primarily, that speedy dissolution 
follows the introduction of a very large dose into the stomach. This 
has recently been established by the experiments of Mr. Brodie. On 
introducing a small quantity of the juice of Aconite, or the essential oil 
of Bitter Almonds diffused in water, or of the leaves of Tobacco into 
the rectum, or in a concentrated state into a wound, the entire loss of 
voluntary motion, and total insensibility was produced, — yet even when 
this state was allowed to continue, until all the external signs of apparent 
death were produced, the heart when exposed to view, was found con- 
tracting with considerable force, and by inflating the lungs and keeping 
up artificial respiration, its action could be kept up nearly to the natural 



86 

standard, for a considerable period. It seems, therefore, that while the 
nervous system was so much affected, the powers of the circulating 
system were little impaired, and the cessation of the function ultimately 
producing death, appears in such cases to arise principally from the res- 
piration being affected, and at length ceasing, in consequence of this 
function being so much more dependent upon the influence of the nerves. 

As the question of the stimulant, or sedative, operation of the Nar- 
cotics, is of importance, not only in a practical consideration, but from 
the character of the individuals who have been opposed to each other 
on this point, it may not be amiss to state the grounds of the discussion. 
. «The reasons assigned for considering the Narcotics sedative, together 
with a refutation of them. 

Rules to be observed in their administration. 

PARTICULAR NARCOTICS. 

Family Papaveracece — Papaver Somniferum, Poppy — Natural History. 
Manner of preparing the extractor opium from the plant. At the time 
the pods become nearly ripe, incisions are made into them in the evening, 
and from them there oozes out a considerable quantity of milky fluid. 
This fluid is scraped off early the next morning from the wounds, with 
an iron scoop, and worked in an earthen pot for a long time in the sun, 
until it becomes of a considerable consistence. This is then made into 
lumps of a globular form, which are covered with the leaves of the 
poppy, or other vegetable, to prevent their running, or sticking together. 
The operation of making the incisions into the Capsules, is repeated three 
times, but the produce gradually decreases in quantity, nor is it of so 
good a quality. The kind most esteemed, is rather soft, and yields to 
the touch, is inflammable, of a blackish brown colour, and has a strong 
smell. 

There are four kinds of opium to be met with in commerce — the Tur- 
key, East-Indian, Egyptian, and the European opium. The quality va- 
ries according to the care taken in its preparation. It is frequently 
found in our markets mixed with the leaves, stalks, seeds, &c. of the 
plant, and the great proportion of these admixtures would lead to the 
conjecture, that the leaves were worked in when the opium was in a sofi 
and recent state, for the purpose of increasing its weight and consistence. 
The quantity of these inert substances is frequently so great, that an 
ounce yields only from 4 1-2 to 5 and 6 drams of soluble, and extractive 
matter. 

It is adulterated with various other substances — with liquorice, when 
the specimen is brittle and tastes sweet— sometimes with gum arabic, or 
tragacanth. It is mixed with sand, and gravel, which is very common, 
in order to increase its weight, and the opium feels gritty between the 
teeth. 

Opium is an article which might very well be cultivated in the Caroli- 
nas and in Georgia — and that to a considerable extent. Some speci- 
mens have been made, which were as pure and as active as the Turkey, 
probably more so. t 



87 

Chemical analysis is as follows : . "'• 

1. A Volatile Oil, in which the odour peculiar to good and well pre- 
pared opium depends. 

2. Gum, including Bassorine. ' : • 

3. Extractive, partly simple, partly more than usually oxiginated. 

4. Resin, with which the colouring matter is closely combined. 

5. Caoutchouc. 

6. Narceine, or Narceina. 

7. Meconine. 

8. Morphia combined with Meconic Acid. 

9. Narcotina.- 

Besides, Sulphates of Lime, and Potash, a brown acid. Lignine. 

Remarks upon a few of these principles. 

The Poppy has been cultivated from very remote antiquity. Among 
the Greeks it served to ornament their gardens, and seems to have been 
known in the time of Horner. It was not less common in the gardens 
of the Romans, since Virgil, in his Georgics, speaks frequently of the 
plant. Opium was first employed internally by Hippocrates, and it is 
probable that its virtues were discovered about that time and in his coun- 
try. Since then, the inestimable benefits which it confers, became dif- 
fused through the world, and in every country, all are ready to acknow- 
ledge the great and important effects derived from this merciful dispen- 
sation of Providence. 

The Application of Opium to Diseases. 

Before entering upon the curative applications of opium, it may be use- 
ful to detail at length, its operations upon the different functions of the 
body. 

1. Upon the Animal Functions. 

2. Upon the Vital Functions. 

3. Upon the Natural Functions. 
Diseases in which Opium is recommended. 

Continued Fevers — Intermittents — In Inflammatory Affections after 
action has been subdued, combined with other articles — In Asthma, Ca- 
tarrh, Phthisis Pulmonalis, Rheumatism, Gout — In the Phlegmasia? of 
the Mucous Membranes, especially of the Prima? Vise — In Dysentery, 
Diarrhsea, Cholera Morbus, Bilious Colic, Colica Pictonum — In Dys- 
pepsia. 

In Hemorrhages — In Tetanus — Mania-a-Potu — Syphilis. 

Its external employment often productive of beneficial effects. 

Opiate enema. 

Opium suppository. 

Its poisonous operation considered — Symptoms — Treatment. The 
first object to be accomplished, is to evacuate the stomach — Emetics of 
the Sulphate of Zinc, and should this fail, of the Sulphate of Copper, 
are usually resorted to. With the evacuation of the stomach, the ap- 
prehensions of danger will be much relieved. After vomiting, the pa- 
tient should be moved about — irritating applications be applied to the 
skin if necessary — and strong coffee, lime juice, or vinegar be given 
diluted, to correct the effects of opium upon the nervous system. 



88 

Should Deglutition be interrupted, and it is impossible to introduce 
an emetic into the stomach, other means must be resorted to. Blood, 
letting may.be employed with caution — but the affusion of cold water 
over the head and shoulders has been found productive of the happiest 
effects in rousing the patient from this state of insensibility. The emetic 
should then be administered as soon as it can be taken, and whenever 
the torpor returns, the cold affusion is to be repeated. 

Should the insensibility of the patient continue, the stomach pump 
must be resorted to. 

V.arious articles have been proposed as Antidotes to Opium — Vinegar, 
. Vegetable Acids — the infusion of Coffee, Chlorine, &c. They have no 
such operation — on the contrary, by being given before the narcotic is 
expelled, by diluting the substance they promote its absorption, and thus' . 
aggravate the symptoms. They are useful, however, after it has been 
Temoved, in counteracting its effects upon the nervous system. 

, Should the means fail, which have been proposed, artificial respiration 
should be attempted, and persevered in some time, since very hopeless 
cases have been restored by this means. 

Opium acts chiefly upon the respiratory and sympathetic ganglia. 
If respiration can be sustained by artificial means, until the sedative in- 
fluence of the opium can be subdued by the recuperative energies of the 
system, life may be preserved. 

Another method of treatment has been recommended by the use of 
emetics per anum. The ecsophagus tube of a stomach pump, is to be in- 
troduced into the rectum, and passed gently up eighteen inches or two 
feet. This being done, half a gallon of tepid water, containing x or xv 
grs. of the tartarised antimony, is to be slowly pumped into the colon. 
The patient will complain of nausea, and an inclination to evacuate the 
bowels, followed by full vomiting, repeated several times successively. 
The evacuations may be renewed by x grs. more, dissolved in a quart 
of water, and introduced as before. The operations which succeed, re- 
lieve the patient considerably, and the narcotic symptoms soon disap- 
pear. 

The same plan may be used in obstinate constipation, and in colic, for 
the purpose of throwing up purgative medicines. 

The habitual use of opium greatly impairs the constitution. The 
persons who accustom themselves to use it, can by no means live without 
it, and are feeble and weak. They are usually thin, and are often of a 
sallow complexion, and look much older than they really are. Some of 
us in this country, may have observed the effects of this deleterious prac- 
tice, which lays the foundation of a number of distressing feelings, usu- 
ally termed nervous, with paleness, emaciation, an apathy equally of 
body and mind, and premature death. 

The Officinal Preparations of Opium. 

Tinct. Opii. 

Elixir Paregoric. 

Denarcotised Laudanum. 

Denarcotised Acidulous Tincture of Opium. Formula. 



89 " 

Salts of Opium. 

Acetate — Citrate Muriate and Sulphate of Morphine. Sulphate of 
Morphine has a considerable resemblance to the Sulphate of Quinine ; 
and as this latter salt may be mixed with it, the practitioner would do 
well to remember the following test proposed by Dr. Paris, by which 
they may be distinguished. It is as follows, that the Sulphate of Mor- 
phine treated by concentrated Nitric Acid becomes red, whereas no 
such effect is produced with the Sulphate of Quinine. 
Doses — of the Tinctura Opii — 

xxv m for an adult 
vj m for a child a year old 
i m for an infant within the month. 
Denarcotised Laudanum 

Dose — the same. 
Denarcotised Acidulated Tincture 
Dose — the same. 

SALTS. 

Morphia — rarely employed in its pure state. 
Acetate Morphia 

Dose — ±, j, ~, j gr. rubbed up with sugar. 
Sulphate Morphia 

Dose — the same. 
Citrate Morphia 

Dose — the same. 
Opium — in substance, i gr. 
The doses of this article will vary with the indications. 
Family Synantherea—LzLCtuca. Virosa— Lactucarium seu Thridax — 
Natural History — Preparation — Powers inferior to the preceding arti- 
cle, but freed from its stupifying operation — applied to the same purposes 
in large doses; 

Family Solanece — Hyosciamus Niger — Henbane — Natural History — 
Effects upon the system — Employed in several diseases as a substitute 
for opium, the good effects of which it often exhibits, without its consti- 
pating the bowels — Useful as a topical application in scirrhus and can- 
cerous affections, and in scrofulous ulcerations, applied in the form of 
cataplasm of the bruised leaves, or as a wash. 
Dose — gr. ij to 3i. 
Datura Stramonium — Thornapple — Indigenous — Natural History — 
Properties — Employed in mania — Epilepsy, particularly that form which 
is regular in its attacks — In Asthma, when uncomplicated — In lessening 
the pain of chronic diseases, as Rheumatism, Tic Doloureaux, Sciatica ; 
in Scrofulous, Venereal, and ill conditioned Ulcers with thickened edges 
and a sanious discharge. — Admintstered in the form of powder — Ex- 
tract from the seeds and plant. Tincture. 
Preparation of the extract. 

Dose, powder, gr. i 
Seeds, gr. 1-2 
Extract, gr. i 

12 



90 

Extract from the seeds, gr. ss. 
Tincture, " " " xx to xxx m. 
Ointment— Preparation — applied to haemorrhoids — to the eye-lids to 
dilate the pupil — as a dressing in scalds and bums, &c. 

Poisonous operation of the stramonium — The capsule, or apples, as 
they are commonly called, being eat by children, symptoms of a distres- 
sing character are produced — These enumerated — Treatment. 

Atropa Belladona — Natural History — i\nalysis — Atropia — Proper- 
ties — Rarely employed internally — Recommended as a preventive of 
Scarlatina— Applied io the eye-lids to produce dilatation of the pupils in 
cataract. 

Dose of the Extract, gr. i, increased. 
Solanum Dulcamara— Bitter Sweet — Natural History — Properties — 
Chiefly employed in cutaneous diseases in the form of decoction of the 
stipites or younger branches. 

Decoction, 1 pint daily. 
Family Umbell-atce — Conium Maculatum — Hemlock — Natural Histo- 
ry — Recommended in Scirrhus and Cancer, but without advantage ex- 
cept as a palliative — In Scrofulous ulcerations, and in Opthalmia — In ul- 
cerations of the secondary stages of Syphilis — In the Neuroses — Glan- 
dular Obstructions. 

Preparation of the extract. 

Administration, beginning with small doses, the quantity to be increas- 
ed until the system becomes sensibly affected by its use — Often an inert 
article from age — Care should be taken in its selection, and a return to 
the original small dose with a fresh parcel. 
Dose, ij grs. to ^ss and 9ii. 
In the treatment of persons poisoned by the use of this article, or any 
other narcotic, the treatment is similar to what has been pointed out, un- 
der opium. It should consist in the speedy evacuation of the substance 
from the stomach. Of the emetics the best is the Sulphate of Zinc, on 
account of its being more quick in its operation. 

After the stomach has been cleansed, a cathartic should be adminis- 
tered, and to lessen the effects of the narcotic upon the system, lemon 
juice, or vinegar, or strong coffee are to be employed. As most nar> 
cotic poisons act by destroying the functions of the brain, respiration 
being suspended because it is under the influence of that organ, life 
may be preserved according to the suggestion of Mr. Brodie, by keep- 
ing up artificial respiration, after death has apparently taken place. 

Cicuta Maculata — American Hemlock — Indigenous — Natural Histo- 
ry — Effects similar to the preceding, only more powerful. 
Dose, ij grs. increased. 
Family Ranunculaceoe — Aconitum Napellus — Wolf's-bane. 
Hydrocyanic Acid — Preparation. Exists abundantly in the vegeta- 
ble kingdom — Effects upon the system — Action decidedly sedative. 
Employed in diseases of increased sensibility and irritability — In Ner- 
vous and Chronic Coughs — In Catarrhal affections and Whooping 
Cough. Also in Phthisis Pulmonalis, Asthma, Dyspeptic affections, 
Tetanus, &c. Evidence of its utility in these cases. 



91 

' Exhibition — Medicinal Prussic Acid employed — To be administered 
in distilled water — to be recently prepared since it is easily discompo- 
sed. 

Dose, i m, increased. Formula. \ 
Poisonous operation — its prompt and fatal effects — Antidotes. It is 
difficult to point out an antidote to an article which operates with such 
great activity — several have been proposed, but until lately with little 
effect. Those most approved, are .diluted aqua ammonia, taken inter- 
nally and applied externally— Chlorine — inhaling the vapour, and inject- 
ing a solution of Chloride of Lime, or Soda into the stomach, when in- 
sensibility exists. 

The best of all remedies is the affusion of cold water, and it should 
be employed in connection with the last mentioned. 

Family Rosacea — Prunus Lauro Cerasus — Cherry Laurel — Natu- 
ralized — Natural History — Effects upon the system similar to the pre- 
ceding — Active principle separated by distillation — Employed in the 
same diseases as the preceding. 

Dose, xxx to xl m of the distilled water 
Tincture of the leaves, x to xx. 
Amygdalis Communis — Bitter Almond — Prussic Acid obtained by 
distillation from the cake which remains after the separation of the fixed 
oil — The acid rising in union with volatile oil, from which it can be sep- 
arated by the red oxide of Mercury. 

Family Papaveraceoz — Sanguinaria Canadensis — Blood Root — Indi- 
genous — Analysis — Natural History — Sanguinarin — Effects npon the 
system diversified, according to the dose — Employed in Rheumatism, 
Hepatic derangements, Pulmonic affections attended with difficult respi- 
ration, cough, and occasional haemorrhage — Pertussis — In some of the 
forms of Dropsy. Externally employed in ill conditioned ulcers — In 
Polypi of the Nose, combined with calomel as a sternutatory. 
Dose, Tincture, xxv to xxx m 
Powder, v grs. 

Infusion, ^i of the powder, to f v of water 
Dose, f ss. 
Family Apocyneoz — StrychnosNux Vomica. Natural History. All 
parts of the plant are extremely bitter, and contain more or less Stryctu 
nia ; but it is from the seeds, that the greatest quantity has been obtained. 
Chemical Analysis. 

Strychnia combined with Igasuric acid, forming an Igasurate of Strych- 
nia — a concrete oil, gum, starch, a small proportion of wax — Bassorine, 
Lignine. 

Besides Stychnia, Nux Vomica contains also another active principle. 
Brucia, in combination with Igasuric acid. 

Medical Properties. Nux Vomica has no odour, but a very bitter 
taste, and when given in large doses, is possessed of very destructive 
properties, producing great disturbance in the functions of the animal 
economy, as anxious breathing, retching and nausea, tremors, violent 
convulsions, tetanic spasms of extraordinary force, asphyxia, and death. 
It exerts an action in a high degree upon the brain and spinal marrow, 



92 

giving excitement to these parts, and through them to the whole muscu- 
lar system of the body. It is possessed of narcotic properties, but in 
many respects differs from most articles of this class, and may be con- 
sidered as peculiar in its operation upon the system. 

But little employed until the experiments of Delile and Magendie upon 
the action of the Upas Teute and its kindred species on animals. 

Employed in paralytic affections, particularly such as arise from an 
impaired state of the nervous energy. The symptoms which are con- 
sidered as favourable in its use, are a sense of thrilling, or throbbing, or 
starting in the affected part or limb, an internal sense of unpleasant heat, 
or an increased sensibility all over the parts deprived of motion. In the 
application of this article to paralytic affections, it would appear to be 
less useful in that species of the disease arising from apoplexy, but to 
be principally advantageous in palsy, arising out of an impaired state of 
the nervous energy, or those cases brought on by excesses of various 
kinds, in narcotics, by metallic influence, by rheumatism, and by acute 
diseases. AH cases arising in any of these causes, are proper objects 
for the use of this article. Dr. Thomson is of opinion, that this arti- 
cle does not influence the circulation of the blood in the brain, unless 
when it is given in sufficient quantities to produce death. He therefore 
recommends it in cases in which the paralysis may have arisen from 
pressure on the brain, yet there is reason to think that benefit may be 
derived from so direct and powerful a stimulant of the nervous energy. 

It is also employed in other cases, connected with muscular relaxation 
of particular parts, as the levator palpebral of the eye-lid. In Inconti- 
nence of Urine, Impotence — In the diseases of the eyes, as Amaurosis. 
It has been given with advantage in Chorea Sancti Viti, and likewise 
for the destruction of intestinal worms, which it is supposed to effect by 
its extreme bitterness. 

Forms of administering this article. 

In substance rasped fine — grs. iv, form of pill 
Alcoholic Extract-- -i to ij grs. 
Strychnia— g. T \. 

The doses of the medicine are to be increased gradually, until the 
expected affection, thrilling, throbbing, tetanic shocks, and prickling, are 
experienced in the affected parts. When these are felt, the augmenta- 
tion of the dose is to be discontinued. If continued after these symp- 
toms are produced, violent tetanic shocks are excited throughout the sys- 
tem, so as to throw the patient from his bed. 

Stychnia is the form of administering this article, which is generall)' 
preferred. It should not be given in its pure state, but combined with 
an acid, so as to form a neutral salt---otherwise it may be inactive from 
its insolubility. 

Great uncertainty is often complained of, in the effects of this article. 
This proceeds from imperfection in its preparation, when it will be 
found to contain Brucia, which is of much less activity ; one grain of 
Strychnia being equal to six of Brucia. 

The purity of Strychnia is determined, by adding to a mixture con- 
taining it, a small quantity of Nitric Acid. The deeper the red which 



93 

is produced, the larger must be the quantity of Brucia present r and no 
Strychnia should be employed, that is tinged more than a pale reddish 
yellow hue, by the Nitric Acid. 

Poisonous operation, of the Nux Vomica — Symptoms — Treatment. 
The first object is to get rid of the offending substance, by the use of 
an emetic, or the stomach pump. The second is to destroy the viru- 
lence of the poison, and for this Durpose a tincture of Iodine should be 
administered, an Ioduret of Strychnia being formed which is not posses, 
sed of active properties. 

Brucine — has been employed in the same diseases as Strychnia, but 
is decidedly inferior in activity, requiring to be given in larger doses. 

Family Urticew — Humulus Lupulus — Hop — Natural History— Lu- 
pulin — Its effects evidently narcotic — and used as a substitute for opium 
when that article disagrees, by producing nervous or ofher distressing 
symptoms. 

Family undetermined — Gelseminum Sempervirens — Yellow Jesamine. 
Natural History — Indigenous — Effects upon the system of an active and, 
powerful character — Employed in Rheumatism — and from its operation 
upon the nervous system may be used as a substitute for Prussic Acid, 
and in the diseases in which that article has been recommended. Bark 
of the root employed in the proportion of 

f i to ibi of spirits. Dose, xxx m. 

ANTISPASMODICS. 

General remarks upon the operation of this class, and the substance 
of which it is composed. In proceeding to speak of the articles of this 
class of medicines, I ought not to disguise that they are very rarely em- 
ployed, at least by myself. So great* a revolution has of late taken 
place in the Pathology, and Treatment of Nervous and Convulsive Dis- 
eases, that the remedies which were once in vogue, are now rarely ad- 
ministered. 

These diseases have for a long time been considered as originating in 
great mobility of the system. By this term was meant, much excitabili- 
ty, connected with a debilitated, or more properly, a delicate habit of 
body. Such, doubtless, is the state of constitution, giving rise to these 
diseases — But it should also be observed, that the phenomena of nervous 
excitement, or the symptoms these diseases present, originate often in 
excited states of the cerebral and spinal systems, and in many instances, 
stimulants particularly of the diffusible kind, comprised under this class, 
are injudicious and improper. Such at least has been my views in the 
management of these cases, particularly during the states of excitement, 
or while the paroxysm is on. 

In many instances, particularly in Hysteria occurring with delicate fe- 
males, I have afforded almost instantaneous relief by depletion, by 
drawing a few ounces of blood, by keeping the apartment cool, by cold 
applications to the head, cold drinks ; and by these simple means more 
prompt and effectual relief has been afforded, than by the whole cata- 
logue of anti-spasmodics successively employed. 



94 

There are periods, however, when these Medicines can be resorted to. 
In the intervals of the paroxysms, they are of use to fortify the nervous 
system, and to calm the irregular and disorderly movements. They 
seem adapted to lessen that irritability which is too readily excited into 
action, upon any, even the most trifling occurrence, which have refer- 
ence .to the feelings and sensibilities. Antispasmodics, though useful, 
are not even here the most approved means. This very excitable state, 
or unequally balanced condition of the system, is often effectually, and I 
believe, most effectually removed, by bringing into action the corporeal 
energies — by giving vigor to the muscular system, by exercise, by to- 
nics, by change of air : of climate, by soothing mental anxieties, or re- 
moving them if practicable, and very often by renewing secretions or 
discharges, which have been interrupted. Of these secretions, the most 
important is the catamenial. 

Subacute forms"" of these diseases will occur, in which a depletory 
course cannot be pursued, and where the chronic remedies which are to 
be resorted to in the Intermissions, cannot be practised. Under these 
circumstances, the Antispasmodics, strictly so called, must be resor- 
ted to. 

It should be observed, that all the substances which we are to consider 
under this class, are vegetable gummy resinous, or aromatic substances, 
or animal substances of much odour, or chemical substances, which are 
very diffusible. It is nevertheless in this vegetable or animal aroma, that 
the diffusible property of these substances resides, and their antispas- 
modic effects. 

PARTICULAR ANTISPASMODICS. 

Family Umbelliferce — Ferula Assafcetida — Natural History. The 
Assafcetida is the concrete juice of the root of this plant, which is pro- 
cured by making a transverse incision of the top of the root, and allow- 
ing the juice to exude upon the surface of the wound. It is scraped off 
by a proper instrument, and exposed to the sun to harden. The same 
operation is repeated until the root is exhausted of its juice, when it soon 
perishes. Properties. The analysis of Assafcetida affords the follow- 
ing results. In 50 grs. of assafcetida, 32-40 are of a particular resin, 
which becomes of a red colour upon exposure to the light. This resin 
has no odour unless it is impregnated with a portion of the essential oil ; 
1-32 of a volatile oil, to which is owing its odour, and acrimony : 
9-72, of a gum resembling Gum Arabic : 5-33, of a matter analogous 
to the gum of Bassora, Malate of Lime. 

The virtues and uses of assafcetida are very considerable. In many 
parts of Arabia and Persia, it forms an important article of the M. M".", 
and is employed largely as a condiment for food. The Banian Indians, 
(who not using animal food, have recourse to the strongest and most 
acrid condiments,) employ assafcetida liberally in cooking, and even 
rub their mouths with it before meals to stimulate their appetites. 

The diseases of the class Neuroses in which it is most commonly em- 
ployed, are Hysteria and Hypocondriasis, and in some of these cases 



95 

its administration will afford relief. It is given during the paroxysm of 
the disorder, and as its effect is not very permanent, the dose should be 
large and frequently repeated. 

In other cases in which it is employed, as Epilepsy and the convulsive 
affections, it is undoubtedly too feeble to contend with them. 

In the diseases of the alimentary canal it is highly serviceable, partic- 
ularly when the powers of digestion are weakened by habits of intem- 
perance. It is also useful in relieving many of the unpleasant symp. 
toms which so frequently attend dyspepsia, It is also employed in the 
form of pill as a carminative in those cases, and it is effectual not only , 
in relieving the bowels of flatus, but has manifestly a laxative operation-. 
Its good effects in these cases are dependent upon its stimulating opera- 
tion ; hence it is employed by the inhabitants of India, to season their 
food, and they regard it as an excellent stomachic. 

In diseases of the Thorax employed — Asthma, Pertussis, secondary 
stages of Catarrh, particularly when following measles. 
Exhibited in watery solution, dose fss 
Tincture, xxx to xl m 

Enema, ji to jii dissolved in x ounces of a decoction of barley. 
Bubon Galbanum — of littl© value. 

Family Valeriana — Valeriana Officinalis — Natural History. The 
root of this plant is perennial and indigenous to England and Germany. 
It grows in moist and dry situations, and its qualities are much influenced 
by the degree of exposure to heat and light, as well as the kind of soil 
in which they are cultivated. The roots which are obtained in a soil 
dry and elevated, have much more odour, and contain more medicinal 
principles than those which are collected in a moist or shady situation. 
Much care should also be observed in collecting the roots. They 
ought not to be taken up until they are two or three years old, and they 
should be gathered before the leaves shoot forth. Properties of the 
root. 

Analysis. A pound of this root is composed of Fecula ^ii, Gum. 
Extract f iss, a Black resin fi, volatile oil 3i, Ligneous matter fxl. 
The camphorated odour and aromatic taste, depend upon the volatile 
oil, its foetid odour, and acrid disagreeable taste to the resin, and the 
sweetish taste to the gummy extract. 

The effects of this article are stimulating in a considerable degree. 
It accelerates the circulation, increases the animal heat, increases some 
of the excretions, as perspiration, and sometimes the urinary. It exer- 
cises a considerable influence upon the nervous system, which is of a 
calming or soothing nature, allaying the agitation, sleeplessness, the 
wandering pains, oppression, which so frequently attend in these cases. 
Employed in the same diseases as assafoetida. In Hemicrania combined 
with Peruvian Bark — In the Typhus states of fever combined with Am- 
monia and Bark. 

The Valerian is exhibited in Substance, Tincture, Infusion and Es- 
sential Oil. 
In Substance the dose is 31 to fss three times a day, though so con- 



96 

siderable a proportion 6f Valerian root consists of mere inert woody- 
fibre, that the powder cannot be considered a commendable form for its 
exhibition. 

In Tincture the dose is 31I to f ss 
Of the Infusion, ^ii three or four times a day. 
The Infusion is prepared by boiling an ounce of the bruised roots 
with twelve ounces of water for ten minutes. Of this, one to two oun- 
,ces may be taken three times a day with the addition of a dram of the 
Tincture. By long boiling its virtues are lost. 

The Essential Oil is given in doses of ij to x drops in a mixture. 
As an Anti-Hysteric, it is usually conjoined with assafcetida, ammonia, 
and other nervous stimulants. 

Family Liliacece — Allium Sativum — Garlic — Natural History — Pro- 
perties — Of little value as an antispasmodic. 

Musk — obtained from the Moschus Moschiferus — An animal some- 
what resembling the rein-deer, inhabiting Siberia, China, Thibet. The 
musk appears to be a peculiar secretion, which is deposited in a small 
sac situated near the umbilicus of the male. 

This pouch or sac is an organ peculiar to the male, and is found un- 
der the skin of the belly, in front of the prepuce. The organ is of an 
oval shape, and the membrane which lines its internal surface, presents 
a number of irregular folds. It has a small orifice. It is in this cavity 
that the musk is accumulated. The secretion has the strongest odour in 
the animals which inhabit Thibet and China. In more northern coun- 
tries it looses a great deal of its aromatic qualities. In the rutting sea- 
son it is formed in the greatest abundance, and its sensible qualities are 
more developed. The pouch in which it is formed, is only rilled in the 
adult males. It is, however, always seen in the young males. 

It is usually imported in .round thin bladders, its natural receptacle, 
covered externally with hair : in general containing not more than two 
drachms. When pure it has a reddish brown colour, and uniform tex- 
ture, with a very diffusive odour and bitter taste. In consequence of its 
high price other substances are frequently mixed with it, or sometimes 
the place of musk is entirely supplied by foreign matters, as blood, as- 
phaltum. Lead is sometimes introduced into the bag to increase its 
weight. To be genuine the bags should have no appearance of having 
been opened. 

Musk has been held in repute as an antispasmodic, and was much es- 
teemed in the treatment of those diseases in which this class of remedies 
is adopted. It possesses very considerable stimulating properties, and 
acts particularly on the nervous system, exciting it in a considerable de- 
gree, and giving activity both to the mental and corporeal energies. It 
has been resorted to in the treatment of Tetanus. Hydrophobia, Epilep- 
sy. It is used more advantageously in the advanced stages of Typhus 
fever, when subsultus tendium, singultus, and low delirium are present. 

In the attacks of retrocedent gout, when falling upon the stomach. 
Recommended in other spasmodic diseases, but with effects not so deci- 
ded as to entitle it to particular attention. 



97 

It is given in doses of x to xx grs. either in the form of pill or mixture. 
Vide Formulae. 

Tincture of Artificial Musk — Preparations-Employed in Pertussis. 

Dose, xv m 
Castor — Obtained from the Castor Fiber — A deposition in both sexes, 
in two sacs or bags, containing a brownish oily matter — Employed in 
Hysteria, Hypochondriasis, &c. Its extremely nauseous taste and smell, 
together with the absence of any very positive properties, has caused it 
to be rejected.' 

Dose, Tincture, 3i to z'tj. 
Sulphuric JEther — Preparation — Properties — Effects upon the sys- 
tem — Employed in many cases when the organs of respiration are affec- 
ted — When a state of congestion exists in the lungs, with an inability to 
expectorate — In Hysteria — Hiccough--- In sea-sickness-— In the advan- 
ced stages of Typhus fever combined with an infusion of green mint. 
External employment. Formula. 
Dose, jss. 
Hoffman's Anodyne Liquor— -Similar to the foregoing— Only weaker. 
Oleum Succini... Natural History— Properties— Employed with ad- 
vantage occasionally, in palpitations of the heart, &c. External Em- 
ployment. 

Dose, x to xxx m. 
Other and opposite remedies frequently Antispasmodic— These enu- 
merated. 

TONICS. 

Under this class are included Stimulants, with powers modified and 
differing very essentially from any of the preceding. Their operation 
is to give tone to the system. In doing this, they do not produce any 
sensible excitement, and by their gradual operation they give vigour and 
activity to the vital powers without any depression following their use. 
In this respect they differ very essentially from any stimulants which 
have been mentioned. These by raising the excitement to a considera- 
ble degree, are quickly followed by proportional languor and debility. 
But in Tonics, their stimulant operation being more slowly exerted, any 
change is much less conspicuous, and the succeeding collapse takes 
place to no considerable extent. Their stimulant effect is principally to 
be observed from their long continued use, when they increase the force 
of the circulation, strengthen the powers of digestion, excite the deficient 
secretions, and restrain them when too profuse. They also give strength 
to the muscular fibre and renovate the actions of the system. Their ac- 
tion is not mechanical, as was once conceived, giving tension or tone, 
(hence the term Tonic,) to the muscular fibre, but it is exerted upon the 
whole system, influenced by laws incident to vitality. 

The action of Tonics will be more satisfactorily exhibited, by conside- 
ring their influence on the different functions of the body. 

1. The Digestive. The stomach is the organ primarily acted upon, 
and from it by nervous communication, the whole system becomes in- 

13 



:,.*• 98 

vigorated. The stomach being improved, digestion is better performed, 
a more abundant and healthy chyle produced, and hence greater 
health and vigour is imparted -to the body. The functions of the sto- 
mach being better performed^ ttie fsecal discharges exhibit a correspond- 
ing improvement in appearance. They are lessened in quantity, and 
are of a more firm consistence, they are retained longer in the Intesti- 
nal canal, and hence costiveness not unfrequently attends the employ, 
ment of 'Tonics. 

Tonics are improperly, exhibited to persons, in whom there is irrita- 
bility of the stomach, and this connected with the presence of Inflam- 
mation. Far from relieving this symptom, digestion will be found still 
further to languish, and there -will be added anxiety, oppression, pains in 
the head, &c. ■■■'■' 

They are improperly exhibited before the Intestinal secretions have 
been altered, and healthy discharges procured. 

They are improperly exhibited when there is determination to par- 
ticular organs, as the head, lungs, liver, and this connected with in- 
flammation. 

2. Upon the Circulation. The contractions of the heart are increased 
in force and energy by the use of tonics. The action of the capillary 
system is strengthened in a considerable degree under their influence, 
and hence they are employed with much advantage in haemorrhages con- 
nected with feeble action, in discharges by the skin, in increased secre- 
tions from the mucous follicles, &c. 

3. Upon the Respiratory System. The action of Tonics in strength- 
ening the powers by which respiration is performed, improves this func- 
tion, without rendering it more frequent. The blood experiences chan- 
ges, it becomes of a more red or vermillion colour, more consistent, 
and less serous. 

4. Upon the Absorbent System. That the action of these vessels is 
improved, is proved by the rapidity with which the Interstitial absorption 
is sometimes carried on, as evinced in the speedy removal of oedematous 
swellings. 

5. Secretion and Exhalation. These functions are most commonly 
diminished under the action of tonics. Connected as they very often 
are when in excess with a debilitated condition of the system, they can 
only be advantageously resorted to under such circumstances. 

6. Nutrition. In favouring digestion, Tonics improve much, nutri- 
tion in general. Under these circumstances the body returns to its 
fullness, the flesh to its firmness, the skin to its clearness, leaving little 
doubt of the advantageous impressions produced by this class. 

7. The Cerebral System. The functions of the brain experience a 
like favourable influence. The senses are more acute and delicate, the 
understanding and memory are exercised with more readiness. The 
powers of locomotion are renewed, a feeling of health, and well being 
animates the frame, and the individual experiences that he is himself 
again. 

It is in these several ways that tonics exert an action friendly to life, 
and to the restoration of an enfeebled system. Upon what principle 



99 

they produce their beneficial effects, is riot exactly known, but.it seems 
to be connected with their bitterness, as most of the vegetable tonics 
are possessed of this property. This t 'however, is not invariably the 
case, as many articles are bitter without being tonic, as digitalis and 
opium, and some of the metallic preparations are tonic, though void of bit- 
terness. 

Divided into vegetable and mineral — The tonic power of the former 
is intimately connected with certain sensible properties. All possess 
these qualities, though in the different articles one may be more pre- 
dominant than another. The purest Bitters, astringents, and aromatics, 
possess more or lesr tonic power. But the most powerful tonics are na-' 
tural combinations of these principles. 

PARTICULAR TONICS. 

Family Rubiacece — Cinchona. Natural History. The genus Cin- 
chona comprehends a large and valuable number of plants. Some of 
them grow to the size of a cherry-tree, the leaves are oblong and lanceo- 
late, the flowers are of a reddish colour, from which is produced a pod, 
in which is found a nut like an almond. 

The soil in which these trees thrive best, is generally a red clayey or 
rocky ground, and especially on the banks of rivers, descending from 
the mountains. 

The season for cutting the bark, is from September to November, 
and much care is taken that the bark is not cut wet, as it would soon 
lose its colour, turn black, and rot. 

On the trees being entirely stripped of their bark, they soon perish, 
and as the number of these trees, to which access could be had, is not 
very considerable, it has been supposed that a sufficient quantity of the 
bark to supply the demand, can not long be procured. Condamine, 
however, asserts that the young trees do not die by losing their bark, and 
as those which are suffered to become old, have time to disseminate and 
propagate, the fear of exhausting this valuable medicine is wholly ground- 
less. Medical History. The most probable history of the discovery of 
the febrifuge virtues of Cinchona is the following, mentioned by Hum- 
boldt, in his travels in South America. The Jesuits had noticed the 
considerable bitterness of the Cinchona, and there being always Medical 
practitioners among the missionaries, it is said they tried an Infusion of 
Cinchona in the Tertian agues, a complaint which is very common in 
some parts of S. America, and having found it succeed in curing the 
disease, began to employ it as a febrifuge. 

The varieties of Cinchona in use, are the pale, yellow, and red bark. 

The Pale Bark, is derived from the Cinchona Officinalis of Linnaeus, 
or the C. Condaminea of Humboldt: and in common language, grey, 
crown, or Loxa bark. It is called Loxa, from the province and port 
where the bark is obtained, and from whence it is exported, and it was 
in this province that the Cinchona was first discovered. It is called 
Crown Bark, from the high estimation in which it was held by the Royal 
family of Spain. It is found in the mountains of Quito and Santa Fee, 
and it was regarded as of a superior quality. What was brought from 
Loxa, a province or jurisdiction in Quito being preferred. 



100 

Description of the Plant, and of the Bark, as met with in the shops. 

The taste of Pale bark is bitter, and slightly astringent. Its flavour 
is slightly aromatic, with a degree of mustiness. It was said to be by 
far the most valuable species of bark, and from its supposed superiority, 
the Spaniards gave it the name of Cascarilla fina. Recent discoveries 
in analytical chemistry contradict this' opinion. From analysis it is 
found to contain from 25 to 30 per cent, less Cinchonine, and Quinine, 
than the Calisaya (a species of yellow bark,) does of Quinine, and the 
proportion of Cinchonine is much greater than the Quinine. 

2. Yellow bark, so named not from its colour being distinctly yellow, 
but because it approaches rather, more to that colour than any other. 
Two species are comprehended under this term. — 

1. Calisaya Arrolenda — rolled Calisaya. This bark is derived from 
Peru, and is very common in the province of Calisaya, from whence it 
takes its name. 

It is derived from the Cinchona Cordifolia — Appearance of the Bark as 
met with in Commerce — One of the most striking characters of this spe- 
cies, is its extremely bitter taste without any trace of astringency, and 
especially its fibrous structure. This is the best species of bark, and it 
is that employed in the manufacture of Quinine, yielding a much larger 
proportion of this salt than any other. 

2. Species — Cinchona Lancifolia — Orange Yellow Bark, rarely met 
with in commerce. 

3- Red bark is derived from the Cinchona pblongifolia. It is a tree 
of considerable size, which grows not only in Peru, but in the kingdom of 
New-Granada. Description of the plant, and appearances of the bark. 
This bark has been thought to possess the virtues of Cinchona in a higher 
degree, and to have been the species used by Morton, Sydenham, and 
Lister, with such success in the treatment of fevers. Experiments 
seemed to confirm these opinions, as it contains both Cinchonine and 
Quinine. From some very late experiments of Mr. Carpenter of Phila- 
delphia, the last salt is less abundant in the red than in the Calisaya by 
at least 20 per cent. The varieties named, do not comprehend all of 
this important genus. It is stated that there are many other species — no 
less than twenty, the history of which is not known, and in consequence 
of the perplexity which arises from their number, and their being fre- 
quently mixed together, the knowledge of this important genus is still 
involved in obscurity. 

Application of Bark to the cure of diseases. 
, In Intermittent Fevers. This important medicine was originally in- 
troduced in the treatment of this form of fever, in which it is admitted 
to exhibit its best effects. Practitioners are united in opinion on this 
point, and the only difference which exists, depends upon the previous 
utility or inutility of evacuating medicines, the proper period of em- 
ploying the bark — the doses — and the manner of administering it. 
These subjects considered. In Remittent Fevers — in Continued Fevers. 
In some of the Phlegmasia?, as Rheumatism, Hemicrania, Dysentery — 
these diseases being the disguised forms which Intermittent fever some- 
times assumes. In the Exanthemata, as small pox, measles, scarlatina. In, 
haemorrhages — As an auxiliary to Surgery, in supporting and improving 



101 , . 

the vis vitse, under extensive bodily injuries, large ulcerations, compound 
fractures, and cases where gangrene is threatened, or actually established. 

Forms of exhibiting Cinchona. 

In Powder. In this form it is now rarely employed. When used it 
may be given united with various substances, as seen in the formulae. 
In Decoction. For the manner of preparing a decoction — Vide For- 
mula. In Infusion. This preparation and the preceding, are best 
adapted to the first stage, of the chronic state of fever, and to those 
stomachs which are weak and delicate. Water being incapable of dis- 
solving the resin of Cinchona, and very little of the alkaloids, in which 
the power of Cinchona is contained, the Infusion is not so efficacious 
when the whole energy of the bark is required. 

The Infusions in boiling water, acidulated with Sulphuric acid, are pre- 
ferable preparations. With the infusion, as the Decoction, the sediment 
which forms after it "has been decanted, should be mixed with the clear 
fluid before being taken. 

Tinctures — very numerous, both simple and compound. Huxham's 
tincture the best. They are chiefly used as auxiliaries to give energy 
to' the decoction, or for weak stomachs. Sulphate of Quinine. Pre- 
paration — Cinchonine — Remarks upon each. One grain of Quinine is 
equal to 3i of Cinchona. Extracts of various kinds. 

Adulterations. Practitioners should not purchase bark in powder, as 
in this state it is always more or less adulterated. Adulterations are 
frequently practised, by uniting with bark of a good quality, others of 
an inferior. Another fraud consists in the admixture of the powder of 
bark, which has been employed in making the extract, or from which 
the Quinine has been obtained, with such as is of a good quality. 

Quinine is frequently adulterated with crystals of the Sulphate of 
Lime — with Starch, &c. We discover such as is of a good quality, by 
the following characters : 

1. When exposed to heat on a slip of Platina foil, it melts like wax, 
and becomes black if there is starch. 

2. It is very sparingly dissolved by water, more so by hot than cold. 

3. It is much more soluble in alcohol. 

4. Iodine has a remarkable effect upon it. A grain of Iodine heated 
in a dram or two of water, produces in a watery solution of the Sul- 
phate Quinine, a copious precipitate of a cinnamon brown colour. 

Pinckneya Pubens — Georgia Bark — Natural History — Indigenous — 
Properties — Application as the preceding. 

Family Aristolochice — Aristolochia Serpentaria — Natural History — In- 
digenous — Sensible and Medicinal Properties — Employed in Typhoid 
states of fever, alone or in combination with Camphor and other dia- 
phoretics, to support the strength, and relieve the distressing symptoms. 
In Remittents combined with Cinchona — To allay irritability of the 
stomach, &c. 

Exhibited in Infusion — 3ii to water ibi 
Tincture. 

Family Hederacecs — Cornus Florida or Dogwood — Natural Histo. 
ry — Indigenous — Analysis — Employed as the Cinchona — Liable to af- 
fect the bowels with pains. This experienced only in its recent state. 



108 

Tincture — Extract. 

Exhibited in the form of Powder, decoction. 

Qornus Sericea. 

Cornus Circinata. 

Quassia A mara — Natural Hi story — Properties-.-Tonic — Stomachic- 
Febrifuge— Useful when the more active tonics, as Cinchona, &c. pro- 
duce head ache, uneasiness of stomach, and febrile symptoms. In im- 
paired conditions of the stomach, brought on by excesses— from consti- 
tutional causes or a relaxed state of the nervous system. In other disor- 
ders of the constitution connected with debility. 

Exhibited in Infusion. 

3i of the rasped wood to water ibi 
Dose, fss. 

The Salts of Iron can be conveniently added to infusions of this arti- 
cle and Colombo, their colour not being changed. 

Family Rosacea— Prunus Virginiana — Wild Cherry Tree — Natural 
History—Indigenous. To its tonic properties must be added those which 
are derived from the Prussic acid it contains. Useful in Intermittents 
combined with other articles of this class. In Pulmonary affections, 
Asthma — In chronic Djarrhsea — In some of the stages of Dyspepsia. 

Exhibited in Infusion — taken freely. 
Powder, 3ss to 3ii 

Decoction useful as a wash for ill conditioned Ulcers. 

Family Synantherece — Eupatorium Perfoliatum — Thoroughwort. — 
Natural History — Indigenous — Useful tonic during convalescence from 
acute or other diseases. 

Exhibited — Infusion used cold, and freely taken. 
Tincture. 

Eupatorium Pilosum — Wild Horehound. 
Used as the preceding. 

Anthemis Nobilis — Natural History — Properties. 

Family Gentianece — Gentiana Lutsea. Natural History. Analysis. 
Gentianin — Tonic and Stomachic — Employed in Dyspeptic affections, 
in the convalescence from fevers, and other cases of debility — The basis 
of most stomachic preparations. 

Exhibited in Infusion, 3ii to water ibi 

Powder often combined with other articles, gr. x to xv. 

Compound Tincture, pi to fsts, a very pleasant preparation. 

Extract. 

Gentiana Catesbei — Blue Gentian — Sampson Snake Root — Natural 
History — Indigenous — Employed in cases of impaired digestion — In dys- 
pepsia — In Pneumonia of a Typhus character, given in the form of de- 
coction, not only improving the general powers, but determining to the 
surface. 

Dose, Tincture, 3II to ^ss. 

Frasera Walteri— American Colombo— Natural History— Indige- 
nous. Properties and uses as the next article. 

Family Meni'spermce--. Menispermum Palmatum— Colombo Root- 
Natural History.-- Useful tonic — communicating vigour to the stomach, 
without nausea or oppression. Has been much recommended in bilious 



103 

vomitings and discharges from the bowels, without any particular advan- 
tage. 

Exhibited in powder variously combined, x to xv grs. 
Infusion^ fss to fiss 
Tincture, 3H fss. , 

Enters into the composition of stomachic preparations. 
Family Rutacece — Cusparia Febrifuga — Augustura Bark — Natural 
History — Properties — But rarely employed. 

Many other Tonics foreign and Indigenous enumerated. 

MINERAL TONICS. 

The most important are the preparations of Iron. Their general ef- 
fects are, to increase the vigour of the circulation, to cause the blood to 
assume a more florid hue. to promote digestion, and excite the secretions, 
or restrain them when they have been morbidly increased — Employed 
in diseases of debility, and chiefly in Chronic affections. The diseases 
in which they are particularly employed enumerated. 

Particular Preparations — Limatura Ferri — Filings of Iron — Objec- 
tionable preparation and rarely employed. 
Dose, grs. v to ^ss. 

Sub Carbonas Ferri — Rubigo Ferri — Carbonate or Rust of Iron — 
Preparation — one of the most valuable articles of this class, and much 
employed to obtain the general effects of Tonics. Given alone or com- 
bined with various articles. 

Formula. Dose, grs. v to 3i. 

Proto Sulphates of Iron — Green Vitriol — Preparation — A more active 
article, and to its tonic, astringent properties are added — Its use requires 
more caution — Combined with vegetable infusions, or given in union 
with vegetable extracts in the form of pills. 
Dose, i to iv grs. 

Prussiate of Iron — Preparation. To the general purposes, for which 
these articles have been applied, has been recommended in Intermittent 
Fevers. 

Dose, grs. iv to vi. 

Tinct. Ferri Muriati — Preparation — Valuable article, and much re- 
sorted to, when the full operation of Iron is desired. Exhibited combi- 
ned with bitter infusions or in drops. 

Formula. Dose, viii to xii m. 

Mineral Chalybeate waters — most important. 

Preparations of Copper — Deuto Sulphate of Copper, or Blue Vitriol — 
Has been employed in the treatment of Intermittent and Remittent Fe- 
vers, either alone or as an auxiliary to Bark. In Epilepsy — In hae- 
morrhages. Given in such doses as the stomach will bear without 
vomiting. 

Employed externally as a wash in obstinate ulcers — In Leucorrhce, 
Gonorrhoea, &c. 

Dose, i to ^ gr. combined with the extract of Bark 
or Gentian. 



104 

Cuprum Ammoniatum'— Rarely employed; 

Zinc — In its metallic state exerts but little action on the system — Pro. 
toxide of Zint — Flowers of Zinc, &c. Preparation — Employed in Ep- 
ilepsy, Hysteria, Chorea — Degree of consideration to which entitled. 

Applied externally as an absorbent— and with simple ointment as an 
application in Chronic ophthalmia; and to Herpetic and other cutaneous 
diseases. 

Dose, grs. v increased. 
Sulphate of Zinc — Also tonic in small doses, and for this and its as- 
tringent properties, has been used in Chronic Dysentery ; In Dyspepsia, 
combined with bitter infusions. Also in Intermittent and Remittent 
Fqvers, combined with HyosciamtiS' — used externally for various pur- 
poses. 

Dose, i to iij grs. 
Nitrate of Silver — Preparation — Employed in Epilepsy, and other 
nervous and convulsive affections — To irritable conditions of the sys- 
tem — Effects of its long continued use. 

Employed externally for various purposes, particularly in Opthalmia. 
Applied in the form of ointment or solution. 

Formula. Dose, % gr. increased. 
Bismuth — Physical properties. 

Oxide Bismuth — Preparation — Employed in debilitated conditions of 
the stomach, particularly in those cases where pain follows the introduc- 
tion of food — In Gastrodynia, Pyrosis, Cardialgia, &c. 
Dose, v grs. increased. 
Aurum-Gold — Preparations — Employed as substitutes for Mercury 
in Syphilitic diseases. Rarely or never administered. 

Arsenicum Album — Properly arsenious Acid — Physical properties — 
Medical History — Employed in Intermittent Fevers — Cases in which it 
is inadmissible — Administration — Useful to alternate its use with Cin- 
chona — In Remittent Fevers — Typhus, Periodical Head-aches— Rheu- 
matism — Cutaneous affections, &c. Comparative operation of Bark 
and Arsenic — Poisonous operation — Follows the external as well as in- 
ternal employment — Symptoms. 

The Treatment to be pursued when a large dose of arsenic has been 
taken — The first object will be to evacuate the stomach — The emetics 
used should be of the mildest character — after vomiting, various sub- 
stances have been proposed with a view of neutralizing the noxious 
substance, or protecting the surface of the alimentary canal from its in- 
fluence — With the former view, sulphurets of Potash and Soda have 
been employed, but very little dependance can be placed upon them — 
Others have been proposed, as Magnesia and Charcoal. From the ex- 
periments of Hume and Bertrand, large doses of arsenic combined with 
these substances have been taken with impunity — hence their utility has 
been inferred after the poison has been swallowed. 

With the second intention, various mucilaginous matters have been 
employed — Milk particularly, should be given — large quantities before 
and after vomiting, since in coagulating it envelopes the poison and 
thereby promotes its discharge. 



105 

Should these means be insufficient, our efforts should then be directed 
to obviate Inflammation, and its consequences. 

Tests for the presence of Arsenic. 

Dose, Fowler's mineral solution. . : 
vi to xii m. 
Arsenious Acid, -fa gr. 

Mineral Acids — Sulphuric Acid — Preparation — Useful in restoring 
tone to the digestive organs — Strengthening the appetite and checking 
the acetous fermentation in the stomach — In Haemorrhages — Colliqua- 
tive sweats in hective Fever — Externally employed in cutaneous dis- 
eases diluted with water as a substitute for sulphur. 

Dose of the acid, vi to viii m in sugar and water. 
Elixir of Vitriol, x to xv m. 

Nilric Acid — Preparation— Employed in Hepatic derangements— Al- 
terative action upon the hepatic secretions — In the secondary forms of 
Syphilis— External Employment — Diluted for checking gangrene and 
promoting granulation. 

United with the Muriatic and forming the Nitromuriatic usefully em- 
ployed in the formation of baths in various states of disease. Prepara- 
tion of the bath. 

Dose, viii to xm in sweetened water. 

Muriatic Acid — Preparation — Employed for the same general purpo- 
ses as the preceding — and for checking the acetous fermentation in the 
stomach — Diluted very freely with water, as a gargle in ulcerated sore 
throats, and in ulceration of the gums — Employed in the state of gas 
for purifying foul wards, and chambers. 

Chlorides of Lime and Soda. Preparation — Much employed as dis- 
infecting agents — In medicine to correct the odour from diseased surfa- 
ces — Applied to scurvy, Tinea capitis, or Porrigo — Psora — and other 
affections of the skin — As a wash in ulcers of ihe uterus and cancers. 
31 to f i of the powder to water 1 pint. 

Chloride of Soda. Preparation — Used as the preceding, and as a 
gargle in ptyalism. 

Other means of restoring tone to the system. 

Change of climate. 

Exercise. 

Sailing. 

Riding. 

Remarks upon each. 

ASTRINGENTS. 

General remarks upon the operation of this class — Astringent prin- 
ciple extensively diffused, and connected with the presence of Tannin. 

VEGETABLE ASTRINGENTS. 

Different species of Oaks — Family Cwpulifcra — Quercus Robur. 
Employed in Intermittent Fevers, but with little advantage ; in Chronic 
discharges, Diarrhasa, Leucorrhcea, and in the formation of gargles. 
14 



■, 106 

Gallce or Galls — Their formation — employed as above. Used in the 
.form of decoction, or pulverized and united with simple cerate as an ap- 
plication to haemorrhoids. 

Family Rubiaceoe Kino — Obtained from several plants, chiefly the 
Nauclea Gambir. Natural History — Analysis. Employed in Inter- 
mittent Fevers; in excessive discharges from the Uterus and Intestinal 
Canal; in Incontinence of Urine, Gleets. Leucorrhoeu, &c. 
Formula. Dose, Tincture, 3i to 3»i 
Powder, gr. x to jss. 
Family Leguminoscz — Lignum Campechianum — Logwood — Natural 
History — Employed in chronic discharges from the bowels and in Cho- 
lera Infantum. 

Dose, decoction, ^ss to f iii 
Extract, 3ss to p. 
Family Geraniacece — Geranium Maculatum — Cranes bill — Natural 
History. Employed as the preceding, and as an injection in Gonorr- 
hoea. In the formation of gargles, and as a wash for chronic and obsti- 
nate ulcerations of the mouth. 
Dose, powder, 3i 
Decoction, fi. 
Family Rosacea — Rubus Villosus et R. Procumbens — Dewberry and 
Blackberry — Properties. Employed as the preceding. 
Dose, decoction of the root, fi to fii. 
Other articles enumerated. 

MINERAL ASTRINGENTS. 

Super Sulphate Alumina with Potash — Physical properties. Em- 
ployed as the preceding articles, and in Hsemorrhnges connected with 
relaxation of the system — In Menorrhagia — Externally employed for 
various purposes — In the formation of Injections combined with any of 
the preceding articles, in Leucorrhaea, Gleets, in the formation of gar- 
gles for cleansing ulcers of the mouth and fauces, or relaxation of the 
uvula. 

In Ophthalmia a pleasant application is formed by coaguling the albu- 
minous portion of an egg. 

As an escharotic in the state of burnt alum. 

Administered in the form of powder. Dose, grs. v to 3i. 
Alum Whey. Preparation. Dose, fi. 

Acetate Lead. Preparation. Objections to its use answered. Em- 
ployed in Haemorrhages from the lungs — Uterus bladder — bowels. In 
Diarrhoea and Dysentery. Formula. In Hydrophobia — Tetanus — 
Externally employed in the formation of collyria — Injections To in- 
flammatory Tumors, &c. Poisonous operation of the Salts of lead — 
Symptoms — Treatment. 

The Salts of Lead when swallowed in large quantities may be so 
neutralized as to become inert. They are readily decomposed by , the 
Sulphate of Soda or Magnesia — forming thereby an insoluble Sulphate 
of Lead, which is not possessed of poisonous properties — The first ob- 



107 

ject of the Physician, when called to a person who has taken a large 
dose of the Acetate of Lead 1 , is to administer copious draughts, con- 
taining a solution of the Sulphate of Soda or Magnesia. It decompo- 
ses the Lead in the manner mentioned. 

Dose, i to ii grs. increased, combined with Opium or 
Laudanum, 
Goulard's Extract. Preparation. Employed in the same diseases 
as the preceding. 

MISCELLANEOUS CLASS. 

Iodine. Natural and Medical History. Properties. Employed in 
Bronchocele or Goitre. Symptoms forbidding its use. In enlargements 
of other glands. In the discussiou of tubercles in the lungs. As an 
Emmenagogue. Administered in the form of pills. Tincture. Solu- 
tion of Hydriodate of Potash. Precautions to be observed in its use. 
Dose, Iodine, gr. j 
Tincture, x to xx m 
Solution, same. 
Externally employed in the form of ointment. Preparation. 
Spongia Usta. Properties as the preceding. 

Family Euphorbia Styllingia Sylvatica. Indigenous. Natural His- 
tory. Properties. Employed in Syphilis, particularly in what is called 
Syphilitic Rheumatism. In Rheumatism, Obstinate ulcerations, Scro- 
fula, &c. Used in ihe form of Decoction — Tincture — Powder. 
Dose, decoction, f i 
Tincture, z'i to ^ii 
Powder, i to v grs. 
Family Ranunculaceoz — Hepatica Triloba. Indigenous. Natural 
History. Properties. Employed in Pulmonary affections, and as a sub- 
tonic in cases of debility. 

Acupuncturation. 

History of this operation and of its mode of action. Description of 
the Needle, and manner of using it. Employed in Rheumatic affections ; 
In Neuralgia, Opthalmia, and for evacuating fluids in anasarca. 

Electricity- 
Its operation of a stimulating character. Tts importance increased by 
the late pathological researches of the French physicians. Effects 
upon the system. Promotes the secretions. Restores muscular energy. 
Employed in Rheumatism. Paralysis. Amenofrhcea and other dis- 
eases. Galvanism. Action similar to the preceding, but as a stimulant 
less intense and more steady. Applied to the same diseases as the pre- 
ceding. Recommended in Asthma, Dyspnoea, Dyspepsia. Galvanic 
machine. 

Plates applied to the surface of the body. 



ALIMENTS. 









A knowledge of dietetics all important and particularly, 
required of the physician. The human subject capable of 
subsisting upon a variety of articles — illustrated by the 
habits of different nations — Holds an immediate station be- 
tween carnivorous and graminivorous animals — illustrated 
by a comparison of his digestive apparatus with theirs — 
Distinction between alimentary and medicinal substances. 

Aliments derived from the vegetable kingdom. 

Nutritive principles in vegetables depend upon Gluten — 
Sugar-Farina — Oils — Mucilage — Remarks upon each — The 
nutritive qualities of vegetables will further depend upon 
the greater or less difficulty with which the digestive organs 
separate the nutritious particles. This will be affected by 
the texture of the article — also by the state of strength or 
weakness of the particular habit of body, or peculiarity of 
constitution — Duty of the Lecturer. 

Remarks upon the digestibility of different substances not 
to be considered absolute, but to correspond with the general 
experience upon the subject. 

1. Of Alimentary substances in which Mucilage chiefly prevails. 
1. Of Leaves of Plants. 

Spinach. 

Cabbage. 

Lettuce. 



Asparagus. 

Turnip. 
Carrot. 
Parsnip. 
Beet 

Artichoke. 

Cucumber. 



Stems. 
Roots. 



Receptacle of Flower. 

Fruits. 
15 



Of the effects of a Mucilaginous Diet. 

Of the diseases in which its use is contra-indicated. 

Of alimentary substances in which Farina chiefly prevails. 

Solanum Tuberosum — Potatoe. 

Marunta Arundinacea — Arrow Root. 

Jatrophia Manihot or Cassava Tree — The root furnishes the 

substance called Tapioca. 
Cycas Circinalis — Species of Palm — the pith of the leaves 

and of the upright shoot furnishing the substance called 

Sago. 

Hordei Semina — Barley 

Secalis Semina — Rye. 

Oryzee Semina — Rice. 

Avenge Semina — Oats. 

Zeee Mayse Semina — Indian Corn. 

Tritici Semina. Wheat The article most commonly 
employed in the preparation of Bread. 

Of Unleavened Bread. 

Of Leavened Bread. 

Of Fresh Bread. 

Stale Bread. 

Toasted Bread. 

Of Pastry and its properties. 

Family jLegwmmos^-Comprehending the varieties of Peas, 
Beans, &c. 

Of the effects of a Farinaceous Diet. 

The diseases in which a Farinaceous diet may properly be 
employed. 

Of alimentary substances in which Oil chiefly prevails. 

Nuts. 

Almonds. 
Their effects upon the system. 
Diseases in which they are improper. 

Of Alimentary substances in which Sugar chiefly prevails. 

Comprises Fruits, ripe, or preserved. 
Their effects upon the system. 
Diseases in which they are improper. 
Of Milk. 

Its value and importance — the changes it undergoes when 
taken into the stomach — Utility as an article of diet in con- 
valescence and in particular diseases. Milk when congula- 



Ill 



ted by acids or wine, forms a pleasant drink, grateful and 
refreshing to the sick. 

ANIMAL FOOD. 

Proximate principles of which animal substances are com- 
posed. 

Gelatine—Albumen— Fibrine— Remarks upon each. — Cir- 
cumstances affecting the digestibilty of animal substances. 
Differences will arise from the texture of the fibre — from age 
— sex — size — from the quantity of oily, fat, and glutinous 
matter they contain — from the manner in which the animal 
has been fed. 

Other circumstances affecting the digestibility of animal 
substances — The food of the animal— The state of motion or 
of rest— its being fat or lean— the flesh being kept a short time. 

Particular food, with remarks upon the digestibility of each. 

Beef. 

Veal. 

Mutton. 

Lamb. 

Pork. 

Wild Meats. 

Domestic Fowls. 

Wild Fowls. 

Eggs. 

Aliments derived from 
Fishes. 

Salt and fresh water. 
Oysters. 

Salted Meats. 

Comparative effects of a diet exclusively animal or vegeta- 
ble—Advantages of a Vegetable diet — Disadvantages — In 
favor of an animal diet — Objections— A mixture of both, the 
proper course to pursue. 

Condiments. 

Consist of Salt, Vinegar, and Aromatics. Remarks upon 
each. 

Cooking of Food. 

Drinks — Water — Varieties — Hard and soft — Spring — Riv- 
era-Rain. 



, IV 

Fermented Liquors. 
Porter. 
Beer. 
Cider. 
Wines. 

Distilled Liquors. 
The proportion of Alcohol contained, is shewn in the fol- 
lowing: Brandy, 53, 39; Rum, 53,63; Gin, 51, 60; Scotch 
; Whiskey, 54, 32— Irish do- 53, 90--Hollands genuine, 59 00. 
As Medicines have advantages over fermental liquors— Less 
liable to become Acid-and therefore preferred in those cases 
when acidity prevails. Employed as stimulants in great 
prostration, and after much exposure. Diseases produced by 
the immoderate use of spirits. 

Of other Drinks. 

Coffee— Stimulating and Refreshing— Becomes injurious 
when excessively indulged in, or drank too strong— W hen to 
this free use, is added sedentary habits, delicate and weak 
constitutions, the organs of digestion become impaired, the 
appetite destroyed, and general debility with nervous symp- 
toms produced. Medicinally employed in Asthma, "and to 
counteract the operation of Narcotics. 

Tea— Properties similar to the preceding— becoming inju- 
rious under similar circumstances. 

v 

FORMULA. 

Formulae referred to in the preceding observations, which 
are introduced to assist those Gentlemen who are unaccus- 
tomed to take Notes, and to furnish others more advanced, 
with a collection, which from experience, will, I think be 
found useful. 

Emetics. 

#. Powdered Ipecacuanha, 3i to 3ss 

Tartarised Antimony, gr. ii 

m— for a powder. 
fy. Tartarised Antimony, gr. iv. 

Prepared Chalk, gr. iv m. 

Divide into 4 powders— a powder to be taken every 15 
minutes until they operate. 

In Asthma. 
fy Tincture of Lobelia 



Comp. syrup of Squills. ' 

Simple Syrup aa f i m, dose 3ii to 3iii : 

To be given every 10 minutes with a little honey during 
the paroxysm, until relief is afforded— smaller doses in the 
intervals. .•••■ 

In Pnemonia and Catarrhs. 
#. Kermes mineral 3ss to 3ii 
Mucilage of Gum Arabic fvi 
Honey fi m, dose 3ii to f ss 

To be taken every 2 hours until the cough is relieved. 

Cathartics. 

Oleaginous mixture. 
#. Castor Oil fi to f ii 
Sugar ^iii 

To be rubbed well with the oil-add slowly mucilage of 
Gum Arabic f v. 

Mint Water 3ii 

Laudanum 3ss— dose f ss to fi repeated every hour 
or two, until relief is obtained. 
Instead of Mucilage, the yolk of an egg may be used, or 
honey, or an emulsion of sweet Almonds, these being em- 
ployed to render the oil misceable with water. 

Fol. Senna, f ss 

Warm water, f xii, simmer a short time, and strain, 

add sulphafe Magnesia fi 
Manna, fi— dose a small cup full every hour or two, 
until it operates. 

#. Sulphate of Potash, or super Tartrate Pot: 

Pulv. Jalap : a 3ii, mix and divide into 4 powders. 

To increase its activity, Calomel may be added,, or Tar- 
tansed Antimony, or Ipecacuanha. One every two hours 
until it operates. 

Or, 

#• Super Tartrate of Potash, sii 

Pulv. Jalapii, 3i— mix and divide into 4 powders. 
Administered as above. 



#. Proto Chloride of Mercury, g. viii 
Pulv. Jalapii, gr. xvi— m. for a dose. 

Powdered Rhubarb may be exhibited combined as the 



VI 



preceding article—or with Magnesia or the Carbonate of 
Soda for Children. 

#• Carbonate of Potash or Soda, gr. xii to 3i 

Pulv. Rhei, Si to 3ss 

Water, fii m 

Dose, sii to ziii every 2 hours pro re nata. 

Rhubarb Tea. 
• p. Pulv. Rhei, sii 

Fennel Seed, sii. Water ? xii. 
Boil until 1-3 is dissipated— Dose, sss to fss, two or three 

times a day for several days. 

P. Powdered Rhubarb 

Powdered Aloes 

Blue pill mass— Each equal parts 

Syrup, gr. s. 
Mix and divide into pills of a convenient size. 
A pill to be taken at bed time, or night and morning, as a 

gentle aperient. 

More active, 
ty. Powdered Aloes. 
Powdered Gamboge. 
Calomel, a si 

Syrup, as much as is necessary— mix and divide 
into Lx pills, ij to iv. a dose. 

#. Powdered Aloes, 31 

Powdered Gamboge, 3ii 
Tartarised Antimony, gr. iv. 

Syr. q. s. mix and divided into xxiv pills— iij at a 
dose, and followed by ij others, in 6 hours if 
necessary. 

Comp. Ext. Colocynth, 3iv 
Ext. Hyosciamus, zss 

Blue Mass, 3i m and divide into xxx pills, — ij to be 
taken at bed time. 



Or, 
Comp. Ext. Colocynth, zi 
Calomel, grs. xv 
Tartarised Antimony, gr. i 

01 Carui v. drops, make into a mass and divide into 
xxiv pills— 1, 2, or 3 every night. 



Vll 



In Scabies. 

#. Flores Sulphuris fi 

Powdered muriate of Ammonia, 31 
Lard, ? iiss fi\ unqt. m. 

Sir John Pi ingle's formula in this disease. 

In Tcenia Capitis. 

#. Sulphuret of Potash, si to 3ii 
Water, fviii, m, for a wash. 



A Bath with the Sulphrets is prepared in the following % 
manner. 

Take fii of the dry Sulphret of Potash dissolved in f viii 

of water. 
To this is added of the Liquid Hydrosulphuret of Potash 
fviii, also of the Liquid Sulphuret of Lime, fvjjj. 
Of this solution fii are sufficient to give to an ordinary 
bath sufficient strength, and the quantity may be increased 
to fiiss. 



For Children. 

#. Calcined Magnesia, 

Powdered Rhubarb — a 3i- — m. divide into 4 pow- 
ders, one every two hours pro re nata. 



Dr. Dewees^s Formula in the Colicy complaints of Children. 

#. Calcined Magnesia, 3i 
Water, fi 

Tinct. Assafsed. lx. m. 
Tinct. Opii, xx m dose, xx drops 
Repeated in an hour or two if not relieved. 



Diaphoretics. 

#. Camphor, gr. viii. 
Opium, gr. i. 

Calomel, gr. ii m. fiat Puly. Repeated • 

according to circumstances. 

Or, 

fy. Camphor, 3ss 

Nitrate of Potash, 3i 
Antimon. Tart. g. 1. m. fiat Pulv. vi. 
To the above Calomel may be added, or substituted for 
either of the last articles. 



Vlll 



Cathartic and Febrifuge mixture, 
fc. Sulphate of Soda, f ii 
Tart. Antimony, grs. ii 
Lemon Juice or vinegar, f i 
Water, f viii f ss to ?i to be taken every 2 hours. 

#. Sulphate of Magnesia, f ss 
Infusion of Senna, fiss 
Tincture of Senna, 31 

Syrup of Ginger, 3i, mix for a draught — To be re- 
peated if necessary. 

Seidlitz Powders. 

$. Tartrate of Potash and Soda, or Rochelle Salt, z\i 

Carbonate of Soda, 3i m. and fold in white paper. 
#. Tartaric Acid, grs. xxxv fold in Blue paper. 
The contents of the white paper are dissolved in the fourth 
of a tumbler of water, and the blue paper in the same quan- 
tity of sweetened water— They are united upon being taken, 
and swallowed during the effervescence. 

#. Infusion of Serpentaria, fxii 
Camphor, 3ss to 3ii 
Spts. Nitr ; Dulc ; f ss 
White Sugar, 3ni — m 
Rub the Camphor with the sugar until it is reduced to a 
fine powder— Add the spirits of Nitre, and then the infusion. 
Strain. 

Dose, fss. 

#. Gum Guaiac, 3i 
Antim. Tart, gr. 1-8. 
Gum Op. gr, 1-2— m ft. Pulv. 

To be repeated as often as the case requires, and recom- 
mended in Chronic Rheumatism. 



#. Rad : Sarsaparilla. 
China Briar Root. 
Sulphuret of Antimony a f viii 
Gum Guaiac, f iiss 
Water xxiv lbs. 



These ingredients are to be simmered in a close vessel for 
12 hours, the steam being prevented from escaping. After 
simmering the time prescribed, to be strained, bottled and 
kept in a cool place. The Antimony is to be coarsely pow- 



ii 



dered, enclosed in a piece of linen rag, and suspended from 
the coyer of the vessel. 

Dose as much as the stomach will bear, and its use contin- 
ued for weeks or months. 



Or, 

Sarsaparilla flbss 

Stylingia, Sylv : fiv 

Shavings of Guaiac, Ibss. 

Sassafras Root, fiv 

Water, 1 gallon. 
Boil for a sufficient length of time, to extract the virtues of 
the articles — Water must therefore he added as it evaporates, 
and it may finally be reduced to two quarts. To this, sugar 
or molasses is added, and the whole reduced to the consis- 
tence of a syrup. To each pint of this * syrup, add, of the 
Perchloride of Mercury, previously dissolved in spirits, grs. ij. 
The dose for an adult will be fss to fi, three or four times a 
day. For children less. 

Further experience in the preparation of the Syrup, indu- 
ces me to recommend that the Sassafras root, and the shavings 
of Guaiac, be added to the decoction, towards the close of 
the boiling — and the Stylingia or Queen's delight, added in 
the form of Saturated Tincture, to the Syrup, in the propor- 
tion of a pint to the gallon. 

The Syrup may be given with, or without the Prechloride, 
according to circumstances. 

To a decoction of the Bark or Ulmus Fulva, or Slippery 
Elm, add 

Sassafras Root, fi 

Bark Mezereon Root, 3ni 

Shavings of Guaiac wood, fi 

Liquorice Root, fi. 

These are to be boiled together an hour and strained. 

#. Tartarised Antimony, gr. viii 
Povvdered Gum Arabic. 
Powdered Liquorice Root a si- 
Dose, ii to iv grs. 

Antimonial Powders. 
#. Nitrate of Potash, zi> 

Tartarised Antimony, gr. i — m. and divide into six 
powders. A powder to be taken every two 
hours. 
16 



Nitrous Powders. 
#. Nitrate of Potash, siss 
Tartarised Antimony, gr. i 
Calomel, gr. viii — m: and divide into ix powders. 



rrr 



Neutral Mixture. 
Take of Lime Juice or Vinegar, ? ii 
Carbonate of Soda, as much as is sufficient to saturate 

it — first dissolving the Soda in a little water. 
Sugar, 3ii • 
Water, fii — 3ss every hour or two. 

Diuretics. 
#, Balsam Copaiva, 3ii to ? ss-^-to be well rubbed with 
powdered gum arabic 
Yolk of an egg, or 

Sweet Almonds blanched, a dozen — add 
Water slowly, fvi 
Sweet Spirits of Nitre, f ss 
Tincture Opii, 31 — Po|p, f ss to fi, repeated frequently. 

Or, 

#. Oil of Copaiva, 3ii 

Powdered Gum Arab, fss 
Cinnamon Water, f ii 
Simple Syrup, fiss 
Tinct. Op. 3ss — Dose, ? ss. 

#. Squill root, 3ii 
Orange peal, sii 

Boiling water, fxii— dose, half a wine-glass every 
two or three hours. 



#. Pried leaves of Tobac^ p 
Water, fxiv 

Spirits of Wine, fii — digest for a week : 

Dose xx drops three times a day. 

#. Root of the Blue Flag, fi 
Button Snake root, sii 
Water, Ibiss, boil to one pint. 

This quantity taken daily in divided doses. 

The two following Formulae should have been inserted un- 
der the preparations of Rhubarb, but were overlooked. They 
are too valuable to be omitted. 



XI 



In Diarrhaas — Intestinal derangements of Children — Cholera. 

#i Powdered Rhubarb, 3SS 
Calcined Magnesia, 31 
Syrup of Morphine, fii 
Mint Water, fviii— m. 

Dose for an adult, fss every hour or two, until re- 
lieved. For children, "51 to Z\\ every two or 
three hours until relieved. 
Syrup of Morphine is prepared as follows : 
#. Sulphat Morphine, gr. iv 

Simple Syrup, ibi — m. 

In Diarrhcea — Cholera Infantum-, tyc. tyc. 

#. Prepared Chalk, 3u 

White Sugar, 311- To be well rubbed together. 
Cinnamon water, fviii 
Elixir Paregoric, f ss m 

f ss to fi for an adult every hour 

or two, until relieved. 
31 to 3iii for children, every hour 
or two, until relieved. 



Emmenagogues — Tonic Formulce. 

#. Powdered Cinchona, f ss 
Powdered Ginger 

Proto Carbonate of Iron a 311 — m. and divide into 
eight or ten powders. 
A powder to be taken two or three times a day. 



#. Sulphate of Iron, 9i 

Gum Myrrh, 31 

Sub carbonate of Pot. 3i 

Sugar, 3ii. 

jSThe articles to be well rubbed together, and during the tri- 
turation add, 

Rose Water, fviiss 

Spirit of Nutmeg, or other 

Aromatic, fss 

Dose, fss to fi. 

Sulphate of Iron, 3ii 



* 



Xll 



Ext. of Gentian or Bark, 31 — m. ft. 
Pil, xx. 



Expectorants. 

Lac Ammoniac fii, prepared by dissolving the gum 

in the proportion of z\ to f viii of water. 
Cinnamon Water,.fii 
Syrup of Squills, -fss 
Elixir Paregoric, sii 
Dose, a table-spoonful as often as is necessary. 

#. Rad. Poly. Seneka, fss 

Water, fviii — boil to one half. 

Dose — a tea-spoonful every half hour or hour, as the ur- 
gency of the symptoms require. 

Dr. Archer's Formula in Croup. 

Pectoral Formula, 
ty. Syrup of Squills, fss 
Honey, fi 

Elixir Paregoric, 311 
Antimonial Wine, siii 
Laudanum, 31 

Water, fvi — m. 

A table-spoonful at night, or as often as circumstances re- 
quire. 

$. Extract of Liquorice 
Gum Arabic, a f ss 

Hot water, fviii — simmer until dissolved. 
Antimonial Wine, 3iii 
Laudanum, 1 to Ix m. 

A table-spoonful to be taken every two or three hours. 



Rubefacients. 
#. Spirits Turpentine 
Olive Oil 

Hartshorn — a fi — m — for a linament. The friction 
to be repeated several times a day. 
To the above, spirits of Camphor, or Laudanum, Oil of 
Amber, or Tinct. of Cantharides may be added. 

Sialogogues. 
Formula in Tinea Capitis — Chancres — Cracked Skin — 
Chronic Eczema. 

#. Red Precipitate, 3u 






Xlll 



Venice Turpentine, f i 

Fresh Butter, or 

Spermaceti Ointment, fiii — m. 



#. Perchloride of Mercury 

Muriate of Ammonia, a gr. xv 

Distilled Water, 3iss !•> rv. A 

Crumb of Bread — as much' as is necessary to make 

amass. 
Divide into 120 pills, each containing f of a gr. 

Or, 

Perchloride of Mercury, gr. iv. 
Alcohol, fi 

xxv m. equal to a J of a gr. 

Stimulants. 

#. Sub. Carbonate of Ammonia, 31 
Mucilage of Gum Arabic, f vi 
Sugar, 311 

Spirits Lavender, C 3ii 

A table-spoonful every hour or two. 



Tft. Camphor, 3ss 

Powdered Gum Arabic 
White Sugar, a 311 
Or, Sweet Almonds blanched, No. vi 
White sugar, 3H 
To be rubbed together until reduced to a fine powder — add 
Water — or ♦ • 

Mint Water, f vi 
, Laudanum, xxx m. 
Dose, a table-spoonful every hour or two. 



$. Piper Cubebs 

Balsam Copaiva,a fss 
Powdered Gum Arabic, 3iii 
Cinnamon Water, fviii 

Dose — two table-spoonfuls three or four times a day. 
Sir A. Coopers Formula. 



#. Balsam Copaiva t 

Tinct. Cubebs, a 1 oz. — m. 
i dr. to iii dr. — frequently. 



■ 



1 XI? . 

Narcotics* 

Medicinal Prussic Acid, viii ra. 
Distilled Water, sviii 
Simple Syrup, q. s. 

Dose — a table-spoonful every two hours. The quan- 
tity of Acid to be increased gradually* 



Antispasmodics* 

#. Sulphuric jEther, ii\ dr. 
Infusion of green Mint, f xvi 
White Sugar, 3ii. 
Dose, fi, every hour or two. 



Tonics. 

#. Powdered Cinchona, fss to fi 

Powdered Nutmeg, Cloves or Cinnamon, dr. ss to 3ii 
Carbonate of Soda, 3ss m. 
And divide into four papers. 
Powdered Serpentaria may be added in place of the aro- 
matics, and the dose taken in a cup of coffee with sugar and 
milk, or red wine, or water, with a small quantity of brandy 
or warm tincture. 

#. Bark of Cinchona, bruised, 1 oz. 

Water, fxvi — boil for ten minutes, and at the close 
add Serpentaria, ii dr. — let it stand for an hour 
and strain — add 
Tincture of Cinchona, fiss 
Dose, f i, as often as necessary. 



$. Sub. Carbonate of Iron 
Powdered Ginger, a gr. v. 
Mix for a powder to be repeated three or four times a day. 
To the above, powdered Colombo may be added. 



#. Tinct. Ferri Mur. vi m. 
Infusion of Quassia 3vj 
Cinnamon Water, vi dr. 

Tinct. Colomb. i dr — m. for a draught. To be re- 
peated several times a day. 

Ointment of the Nitrate of Silver, in Opthalmia. 
#. Nitrate of Silver, gr. ii to x. 

Solution of Subacetate of Lead, xv m. 
Simple ointment, 3i. 



The Nitrate of Silver is first powdered finely, and mixed 
with the ointment on a slab— the solution being added after- 
wards. 

Or, 

The Solution substituted.' 
#. Nitrate of Silver, ii to viii grs.. 

Water, ?i. Applied to the eye with a camel's hair 
pencil, or dropped upon the eye. 

Astringents. 

#. Tinct. Kino, f ss 

Solut. Gum Arab, f iv 
Vin Antimon. f ss 
Tinct. Opii, i dr — m. 
A table-spoonful every three hours after the bowels are 
evacuated. 



In Gleets. 

#. Kino, i dr. 
Alum, i dr. 

Mucilage of Gum Arabic, f i 

Water, fti. to be well united together and filtered for 
use. 

Mr. Bell's Formula. 



In Dysentery and Diarrhoea. 

#. Sac Saturn, gr. xii 
Pulv. Ipecac, gr. vi 
Gum Opii, gr. iv 

Syrup, gr. s m. and divide in viii pills, one every two 
hours until relief is afforded. 



11 1 HriMMMfc 



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